Burnout on the way down, but “pajama time” stands still

AMA News Wire

Burnout on the way down, but “pajama time” stands still

Aug 13, 2024

Physicians are increasingly burdened by excessive “pajama time,” sacrificing personal and family time to complete administrative tasks outside of regular work hours. Exacerbated by the growing demands of EHRs, this leads to heightened levels of physician burnout and takes a toll on doctors’ well-being and overall job satisfaction. But this isn’t new. It has been an ongoing issue for years and physicians aren’t finding a reduction in the time spent on the EHR outside of work, according to an exclusive survey from the AMA.

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More than 12,400 responses from physicians across 31 states were received from 81 health systems and organizations who participated in the AMA Organizational Biopsy^® last year. The AMA national physician comparison report—which is exclusive data to the AMA that is not published anywhere else—reflects 2023 trends in six key performance indicators: job satisfaction, job stress, burnout, intent to leave an organization, feeling valued by an organization and total hours spent per week on work-related activities (known as “time spend”).

The purpose of the aggregated data is to provide a national summary of organizational well-being and to serve as a comparison for other health care organizations. The results may be limited by the health systems that chose to participate.

In 2023, 48.2% of physicians reported experiencing at least one symptom of burnout, down from 53% in 2022. Contributing to burnout is time spent on administrative tasks outside of work hours. For 2023, physicians reported having a 59-hour workweek, spending 27.3 hours on direct patient care, 14.1 hours on indirect patient care and 7.9 hours on administrative tasks. This is similar to 2022 levels, when the average workweek was 58.6 hours.

For 2023, here is what AMA data reveals about total hours spent per week on work-related activities and how they vary based on physician specialty:

Hospital medicine: 67.3 hours.
Internal medicine: 59.8 hours.
Obstetrics and gynecology: 59.1 hours.
Family medicine: 55.5 hours.
Pediatrics: 54.3 hours.
Emergency medicine: 53.3 hours.

Additionally, respondents who were one to five years out of training reported a 60.4-hour workweek.

Meanwhile, 20.9% of physicians reported spending more than eight hours on the EHR outside the normal work hours of 5:30 p.m. to 7 a.m. on weekdays, which is the same amount of pajama time as in 2022. Similarly, 14% spent six to eight hours outside of work on the EHR in 2022 and 2023. Additionally, about 26% of respondents reported spending zero to two hours a week on the EHR outside of work.

With little movement on time spent on the EHR outside of work, this signals an urgent need to find solutions to reduce physicians’ pajama time.

At Sutter Health, physicians saw a decrease in time spent on the EHR each day, dropping from 54.53 minutes to 46.69 minutes a day—a 14% reduction. Sutter Health is a member of the AMA Health System Program, which provides enterprise solutions to equip leadership, physicians and care teams with resources to help drive the future of medicine.

Here is how Sutter Health has taken steps to reduce the time physicians spend on the EHR outside of normal work hours at medical group and system levels.

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Help with documentation

“In ob-gyn … having a chaperone in the room is very important as it is with other fields. So, in 2022, we morphed the scribe and chaperone and called them documentation specialists,” said Laurie Gregg, MD, an ob-gyn in Sacramento, California, and chief wellness officer for Sutter Independent Physicians, an independent physician association with Sutter Health. “That has already helped us because we have to bring a chaperone in anyway.”

Laurie Gregg, MD

“So, we’ve trained our medical assistants—who are usually our chaperones—to be our documentation specialists. It makes it not only a more efficient time period, but more comfortable for the patient,” said Dr. Gregg, noting “there’s a medical assistant the patient knows who is notetaking, helping with procedures and chaperoning. That is a big multi-tasking win.”

“That was done at our Sutter independent physician medical group level and is still being used in those specialties who need chaperones,” she said. “The patients almost don’t notice that a chaperone is in the room because they are busy doing their work and then we get half our note written and our mammogram order keyed up before the visit is over.”

Turn to physician champions

“Also, in our independent physician association, we are big on incentivizing our physicians to be more efficient, so we have EHR-optimization visits through physicians who are EHR champions,” Dr. Gregg said. “We give incentive pay for physicians to sit with other physicians one-on-one for an hour to learn some tips and tricks.”

We incentivize them to do it because we feel it’s so important,” she said. Physicians have been taking advantage of that and once they have a session with an EHR champion, “they really notice that they’ve cut their time going forward.”

Physicians who need help with the EHR can reach out to the champions to set up a session. But it isn’t just for physicians who struggle with using the EHR. It can also be helpful for physicians who want to become even more adept at using the EHR.

Educate on note bloat

With the help of the AMA’s “Debunking Regulatory Myths” series, Dr. Gregg learned more about using time rather than documentation elements for patient visits. The myth on documenting time for each task during outpatient visits demonstrated how physicians can now choose to bill based on documentation of medical decision-making or the total time spent on the encounter.

“Now that we can use time-based billing instead of note-documentation billing, that has really made the difference for me and a lot of my colleagues,” Dr. Gregg said. But not enough physicians knew about this, so “we educate to that a lot.”

“I’m surprised more people haven’t really taken it up. They’re still writing really long notes … and for other clinicians reading those notes, it’s a lot of time,” she said.

Part of the education is using the AMA STEPS Forward^® toolkit, “Simplified Outpatient Documentation and Coding,” to guide the conversation and provide examples.

Use AI for documentation, responses

Sutter Health has also used augmented intelligence (AI)—also known as artificial intelligence—to help with documentation and patient portal messages.

“AI listens to the patient-physician visit and drafts the visit note,” Dr. Gregg said, adding that AI also “can craft an initial response to a patient message that the physician revises and sends back.”

The initial pilots of AI throughout the Sutter Health system have shown some promise and are still being analyzed and perfected.

Build a team for inbox management

Every six months, physicians at Sutter Independent Physicians are encouraged to complete innovation projects. If physicians can’t think of innovation projects to do, “we give them preprepared innovation projects,” Dr. Gregg said.

“Team inbox, as we call it, is one of those preprepared ones and we don’t dictate exactly how they do it,” she said. “We say over six months, if you can create something where not only the doctor touches the inbox, but at least somebody else—medical assistant, nurse—then that meets one criteria for the innovation project and it’s another incentive for them.”