Letting doctors delegate can help reduce physician burnout

AMA News Wire

Letting doctors delegate can help reduce physician burnout

Aug 20, 2024

The dynamics of effective health care rely on the collaboration and cooperation among physicians and other health professionals. But when barriers to teamwork are present, the consequences can be severe, leading to increased levels of physician burnout, according to an exclusive survey from the AMA. Addressing the barriers to teamwork and finding solutions is essential for fostering a supportive and efficient medical environment.

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As the leader in physician well-being, the AMA is reducing physician burnout by removing administrative burdens and providing real-world solutions to help doctors rediscover the Joy in Medicine™.

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 physician burnout is a lack of teamwork for collaborating on administrative tasks.

With barriers to teamwork, physicians take on more administrative tasks than they should. For 2023, when asked what prevents physicians from delegating more order entry, medication review, visit note documentation, forms completion or processing prescription renewals to support staff, the common barriers to teamwork were:

I do not have enough medical assistants or nurses—55.7%.
My institution’s culture or policies don’t support or allow such delegation—44.2%.
My EHR isn’t built to support this delegation—30.4%.
I do not trust my medical assistant or nurse to reliably do the work well—19.6%.
State and federal policies don’t allow such delegation—14.6%.

Meanwhile, looking at team function, physicians were asked what proportion of time tasks are done by someone other than them in their ambulatory practice. The tasks done by someone other than the physician more than 75% of the time were:

Prior authorizations—52.5%.
Initial triage of patient portal and inbox messages—33.4%.
Tracking follow-up visits or referrals—31%.
Conducting medication reconciliation with patient and comparing with medical record—30.1%.
Helping to process prescription requests—27.1%.
Entering orders for follow-up visits or referrals—18.3%.
Communicating test results to patients outside of regular office visits—17.4%.
Entering orders for diagnostic tests into the computerized order system—14.3%.

Here is how Northwell Health—which has more than 12,000 credentialed physicians and is New York’s largest health system—fosters a supportive environment that values teamwork.

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Adjust workflows in the EHR

“If there is a clinical initiative that needs to be fostered with an IT solution, that’s when leaders come to me,” said Mariana Karavolias, MD, a pediatrician in Bayside and Astoria, New York, as well as ambulatory associate chief medical officer for Northwell Health.

For example, Northwell Health in July started an initiative to make it easier for physicians to delegate certain tasks to medical assistants (MAs).

That required supporting the change “from an IT standpoint,” said Dr. Karavolias. Now when physicians review laboratory results, they interpret as normal and they can use the existing task functionality in the EHR to say, “Call patient with results” and assign this task to the medical assistant following verification of normal labs.

Mariana Karavolias, MD

“With one checkbox, it would generate a task that would fall on a shared work list for clinical staff to pick up,” she explained. “That meant both nursing staff and MAs. The key there is MAs had the same access as nurses did to those results. Then they would see which ones the physician interpreted as normal, and they would call the patient to let them know their labs are normal.”

“We created and operationalized a standard workflow that utilized the existing functionality where—when clinical support staff picked up that task—it would create documentation that checked off all the boxes, what they communicated to the patient, that they received that initial communication from the provider that it was interpreted as normal and then a timestamp as to when they did it,” Dr. Karavolias said. “We made it transparent so that it wasn’t burdensome to the physician.”

“But we also wanted to make it beneficial—that with one click you’re doing all required steps in the workflow versus it being very labor-intensive and requiring a lot of muscle memory to complete,” she said. “We did this by leveraging an EHR menu that physicians already were interacting with to review lab results, so we weren’t asking them to navigate somewhere else.”

Dr. Karavolias noted that, “as a physician, there are only so many patients I can get to and every day I need to prioritize the sicker patients and my patients with those normal labs sometimes can be left hanging. “Unfortunately, I hesitantly may set an expectation with patients that, ‘No news is good news’ because I may not have the bandwidth to call each and every one of them.

“Knowing that I have someone from my staff—whether it’s an MA or nurse—that can make that phone call and tell a patient their labs are normal improves the quality of care and patient satisfaction,” she added.

“From the very beginning, the unwavering support and leadership of our senior vice president and executive director, Mark Talamini, and our executive vice president and chief nursing officer, Maureen White, have been instrumental in advancing the … changes for our medical assistants,” said Candice Halinski, NP, RN, deputy chief nursing officer at Northwell Health. “Their dedication and commitment have been crucial in gaining the necessary support and endorsement for this initiative, ensuring that we continue to provide exceptional care to our patients.”

Clarify regulatory myths

“It was assumed for many years that in New York State, because medical assistants do not carry licensure, they were not permitted to act or serve in this capacity,” said Halinski. “In doing the research—not only for New York State, but for the practice act—through the AMA I found the ‘Debunking Regulatory Myths’ series.”

“One of the myths was on who can document in the EMR on behalf of the physician,” Halinski said. With those AMA reference materials at the ready, Halinski was able to point out that delegating test-results communication to other health professionals is permitted.

Candice Halinski, NP, RN

“That was huge for the project,” she added.

“The process was lengthy with extensive advocacy efforts,” Halinski said. That is why it was important to “engage in advocacy efforts to amend restrictive regulations and support more flexible task delegation.”

To do that, “begin at department or service line levels, leading to regional, organizational, local, state and national levels,” she advised. But remember to “start small. No mountain is insurmountable if we go one step at a time.”

Learn more with an AMA STEPS Forward^®toolkit, the “Reducing Regulatory Burden Playbook,” about how to avoid overinterpreting the rules.

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Embrace daily team huddles

“Every morning—at least at my clinical site—before we start the day, we go over who is supporting what physician and what their role is for the day,” Dr. Karavolias said. Then “we go over the patient schedule to understand what we can anticipate when the patient comes in.”

“That collaborative approach between all staff will be part of the patient’s experience, from the front desk all the way down to the physician,” she said.

“Always keep the focus on how teamwork can enhance patient care and outcomes,” Halinski said. “This concept should be the focus of each initiative. If we hold this one idea to be our true north, we will never steer wrong.”

Keep teams in the loop

“The other piece of it, because we’re so large and geographically spread out, is we rely on a lot of different communication platforms for teamwork,” Halinski said. “To put this message out, there were a lot of messaging components. There was a lot of going to different meetings and platforms to communicate out this message to make sure teams understood it.”

Success of this was dependent on that “consistent messaging so that what physicians or provider leadership was saying was the same thing that nursing leadership was saying and was the same thing that operational leadership was saying,” Dr. Karavolias said. It’s about “communicating the same message and standard of care across the board.”