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In today’s AMA Update, Christine Sinsky, MD, the vice president of professional satisfaction, AMA, discusses how the AMA plans to continue its critical work to reduce physician burnout and enhance well-being in 2023. AMA Chief Experience Officer Todd Unger hosts.
Learn how the AMA is #FightingForDocs and access resources from the AMA Recovery Plan for America’s Physicians.
- Christine Sinsky, MD, vice president, professional satisfaction, AMA
Unger: Hello and welcome to the AMA Update video and podcast. As we kick off a new year, we'd like to take this opportunity to talk about how the AMA plans to continue its critical work to reduce physician burnout and enhance well-being in 2023. I'm joined today by Dr. Christine Sinsky, AMA's vice president of professional satisfaction in Madison, Wisconsin. I'm Todd Unger, AMA's chief experience officer in Chicago. Welcome, Dr. Sinsky.
Dr. Sinsky: Thanks, Todd. It's great to be with you.
Unger: As you know in 2022, the AMA launched its Recovery Plan for America's Physicians. And, of course, a huge part of that plan was and continues to be reducing physician burnout. While the AMA was addressing physician burnout for a long time before the pandemic, we've seen the problem get a lot worse over the last three years.
So Dr. Sinsky when you look back at 2022, what was the biggest challenge or roadblock to reducing burnout? And how does that compare to previous years?
Dr. Sinsky: Yeah, thanks, Todd. Great question. And as you said, at the AMA, we've been working on reducing physician burnout for over a decade. And as I think about 2022, I think the biggest issue that's arisen has been the workforce shortage of the clinical support staff.
We know that many physicians spend more than half their day on tasks that don't require their medical education, the 11 to 14 years of investment in training to become a physician. And we know what good teamwork looks like and who should be on the team and how the task and care should be shared with well-trained team members. But right now, there, often, just aren't enough people to fill those positions. So that, I would say, is the biggest challenge for us in 2022.
Unger: Well, one of the things that we learned in 2022—I think that was a bit of a shocker—was really how we've seen the trajectory with physician burnout. And that was quantified by a study that was published in the Mayo Clinic proceedings back in September of 2022. Just remind us for starters, Dr. Sinsky, about what the study revealed at the top level.
Dr. Sinsky: Right. So what we found in that study was at the end of the second year of the pandemic, fully 63% of physicians are experiencing some sign of burnout across the United States. And that reverses a six-year downward trend that we've been observing in burnout rates. And it's a marked jump up from 38% just one year earlier toward the end of the first year of the pandemic.
And along with that, well, a year ago, about three-fourths of physicians would choose to be a physician again. A year later, at the end of the second year of the pandemic, that number has dropped to only half. So it says to me that burnout rates have gone up. Satisfaction in the role of being a physician has really dropped.
Unger: And we know from other figures that 1-in-5 physicians planning to leave the profession. This kind of overwhelming nature, I think, which originally, as we've talked over the years, comes from system-level issues complicated by the staffing problems and the team problems that you're talking about. Has our understanding now of physician burnout changed since then? What is there new in this research that we should know about?
Dr. Sinsky: Yeah, well, 2022 was actually a really big year for research in burnout not only in terms of prevalence, which we just talked about, but also drivers and consequences of burnout. And so we published a study just in November of this year in JAMA Health Forum. It was a study where we looked at over 20,000 physicians.
And we found the things that really decreased burnout or were associated with lower levels of burnout were things like control over your work environment. So physicians who rated their control over their work environment as high had 39% burnout compared to physicians who rated their control low, who had 75% burnout. So burnout is almost half in those who have some sense of control.
And we find similar data for those who have chaotic versus nonchaotic work environments, that burnout rates are about half in those who rate their work environment as not chaotic. Likewise, if you have strong teamwork, you're much less likely to be burned out. And if you feel valued by your organization, you're much less likely to be burned out. So that was one big area.
And I would say the other big area is around gender, and that we have observed that the pandemic has just been worse for women. And the electronic health record has been worse for women. And if you'd like, I'll share with you a study we just published on that issue.
Unger: Absolutely. What did you learn?
Dr. Sinsky: Well, what we learned was that women spend much more time on the electronic health record than males in the same specialty. So in primary care, women are spending 108 minutes more for every eight hours of patient schedule time on the electronic health record than male counterparts, that women are spending over an hour more of pajama time, work outside of work, for every eight hours of patient schedule time compared to their male colleagues, and that that gap has increased over the last three years of the pandemic.
So that EHR is more time-consuming for women. And over the course of the pandemic, that has gotten worse for women at a greater rate than for men.
Unger: That's really interesting because I know from our past conversations, these facts around EHR and amount of time people are spending behind the screen and not in patient care has been a tremendous source, issues around burnout. And now you're pointing out there's a gender difference between those. And I'm sure we're going to learn a lot more about in the coming years.
You talked about things that make a lot of sense. Like, you're in an environment where you don't feel like there's a lot of control and it's chaotic. You don't feel recognized and appreciated. I mean, these are all things that would make a lot of sense in terms of their contribution.
Obviously, this kind of combination of things could have a really big impact on the U.S. health care system in the months to come. And it's not about physicians just alone. It's about the care team in general. How do you think about the far-reaching impact of what we're seeing right now that people might not realize at first blush?
Dr. Sinsky: Right. So, Todd, the way I think about it is if you care about patient safety, you have to care about burnout among physicians and among the health care team. For example, we make twice as many mistakes when we're experiencing burnout compared to when we aren't. If you care about health care costs, you have to care about burnout because we know that physician burnout costs over $5 billion every year by very conservative estimates.
So whoever you are, including if you're an insurance company, you need to care about burnout and be invested in reducing it. And if you care about patients having access to care, you have to care about burnout. As you said, 1-in-5 physicians are now indicating that it is likely that they will leave their current practice in the next two years. Many of these will leave medicine altogether. And so as our workforce shrinks, then access to care becomes more difficult.
And in addition to that and potentially even more worrisome is that 1-in-3 physicians anticipates cutting back on their work hours that is going to part time or going further into part time, again, reducing the access that patients will have to their care. And burnout is a major driver of those intentions.
Unger: Well, it sounds like we have our work cut out for us despite all the progress and the increase in the understanding that we've seen over the past few years. As you look ahead to this year, 2023, where do you think the greatest opportunities are to make a difference?
Dr. Sinsky: Yeah, so one of our primary areas of focus for 2023 is going to be a continued focus on the inbox. And I know for people who aren't in clinical practice, that can sound a little bit like a pretty surprising area to focus.
But I will tell you that physicians aren't so much leaving their jobs. They are leaving their inboxes, that the rise in patient portal messages to 157% of what they were at prepandemic levels, the number of low-value notifications that are clogging up the inbox for physicians has just become unmanageable. And so physicians say, I would stay in practice. But I cannot give up several hours of my personal time every night to clearing the inbox.
And so because of that, we're sponsoring several research projects around the inbox using audit log data from the electronic health record. We're cosponsoring a national conference on the inbox at UCSF to bring together what we know and to develop a research agenda around inbox. And at the AMA, we're creating an inbox reduction checklist that will become available online soon as part of our STEPS Forward resources to guide physicians and health system leaders for practical steps they can take to substantially reduce the volume of incoming messages in the inbox.
Unger: That sounds like—first of all, those are incredible statistics that you laid out there beginning, 157% increase. That's on top of the work that folks are doing already in the EHR. Now, all that correspondence related to the portals, that research I'm sure will be very valuable in understanding a path forward. Anything else that you're particularly excited about in the coming year? And how do we get more physicians and other stakeholders excited about making progress in this area as well?
Dr. Sinsky: Yeah, yeah, well, the last thing we talked about was very tactical, and that was inbox. The thing I'm most excited about is much more at a high level in the abstract, but I think it's the secret sauce and that is relationships. So I think relationships are the secret sauce, the pathway by which we are going to get to the other outcomes that we seek.
And I think that's also how we engage others because relationships get to the heart. They get to the mission of why we are doing this work. And I don't mean just relationships between physicians and their patients, very, very important but also between physicians and other health care workers, between nurses and receptionists, between ambulatory facilities and inpatient facilities.
And I think there's so much potential to achieve the quadruple aim of better care for individuals, better health for populations at lower cost while supporting the well-being of the workforce, that my challenge will be to ask every stakeholder within the health care universe, how would this decision look differently if you prioritized relationships? How can I, in my sphere of influence, ensure that relationships are supported rather than thwarted, knowing that that's how we will deliver better care for patients?
Unger: That is great insight. And, Dr. Sinsky, thank you and the team at the AMA for just all of these contributions, research, practical advice, otherwise. You heard Dr. Sinsky talk about STEPS Forward. For folks out there, take a look at the STEPS Forward modules on the AMA. They're just full of practical advice for how you can make tangible changes in your practice and reduce a lot of that burden and restore that joy in medicine that you're all looking for.
Dr. Sinsky, thanks so much for being here today. We'll look forward to continuing the conversations about burnout and increasing well-being throughout the year. You can find all our videos here at ama-assn.org/podcasts. Thanks for joining us today. Please take care.
Disclaimer: The viewpoints expressed in this podcast are those of the participants and/or do not necessarily reflect the views and policies of the AMA.