Physician Health

How the biggest medical group in the U.S. is tackling burnout

Georgia Garvey , Contributing News Writer

When tackling physician burnout, health care leaders must be prepared to use every tool in the well-being armamentarium—from organizational culture to practice efficacy—as part of a holistic framework, according to Amanjot Singh Sethi, MD, a urologist who directs wellness operations at the nation’s largest medical group.

Physician burnout demands urgent action

The AMA is leading the national effort to solve the growing physician burnout crisis. We're working to eliminate the dysfunction in health care by removing the obstacles and burdens that interfere with patient care.

“This really reflects the comprehensive nature of the tactics that are needed to support physician well-being,” Dr. Sethi, of The Permanente Medical Group Inc., said in a Becker’s Hospital Review webinar.

Dr. Sethi and Ellie Farahabadi, MD, associate executive director at The Permanente Medical Group, joined AMA experts for the webinar. The physician leaders detailed their work to prevent and mitigate burnout at The Permanente Medical Group, which is a member of the AMA Health System Program that provides enterprise solutions to equip leadership, physicians and care teams with resources to help drive the future of medicine.

Reducing physician burnout is a critical component of the AMA Recovery Plan for America’s Physicians.

Far too many American physicians experience burnout. That’s why the AMA develops resources that prioritize well-being and highlight workflow changes so physicians can focus on what matters—patient care.

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The Permanente Medical Group includes almost 10,000 physicians, more than 40,000 nurses and other administrative staff and serves more than 4.6 million patients across Northern California. That scale makes finding solutions for burnout even more complicated.

The Permanente Medical Group has some of the “best physician retention rates in the nation,” but even they saw a slight increase in attrition rates during the pandemic, Dr. Farahabadi said. Though that trend has now stabilized and begun to reverse, integrating wellness in operations must continue to be a priority, she added.

“We really want to go back, first and foremost, to retaining the exceptional talent that we have,” Dr. Farahabadi said, adding that one way to do that is to provide physicians with the kind of environment that supports physicians in daily practice and provides opportunities for professional development. “Physicians are also seeking more flexibility and more autonomy.”

Efforts have included allowing physicians to take out forgivable loans and ensuring well-being efforts are as diverse as the population being served. Dr. Sethi recalled the way one occupational medicine chief took on the topic.

Based on survey data and other feedback, the occupational medicine department completely “revamped their entire huddle process,” each day celebrating accomplishments and instituting a round robin in which people discussed their biggest challenges. Improvements soon followed, said Dr. Sethi, who was featured in an episode of “AMA Update” earlier this year on evidence-based strategies to help doctors recapture joy in medicine.

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One of the continued stressors on physicians is the time spent managing their inbox and completing documentation in the EHR. During the height of the pandemic, patients began to rely on technology to fill in the gaps of in-person care, and they have continued to use those electronic formats, Drs. Farahabadi and Sethi noted.

The result has been a phenomenal increase in demands on physicians.

“If this was a problem that was easy to figure out, the medical industry would have figured it out,” Dr. Sethi said. “We’re willing to roll up our sleeves and continue tackling it.”

Creativity will be required, the two physician leaders said. In some Permanente Medical Group practices, nurses and administrative staff have been able to take on inbox messages that don’t require physician input. Dr. Farahabadi, who oversees physician human resources, recruitment, and education and development, discussed using technology tools, training, and team-based care to reduce the time spent on clerical duties.

Innovative solutions to the factors driving physician burnout tend to come from the bottom up, which means operational leaders “don’t need to have all the answers or solutions,” Dr. Sethi said.

“Please ask your people what matters to them,” he said. “Ultimately, it’s all about continuous improvement.”

Learn more with the AMA about measuring and addressing physician burnout.