When AMA member Scott Rissmiller, MD, became chief physician executive at Atrium Health and met one-on-one with the CEO, he explained that he wanted his absolute top priority to be a focus on reducing burnout and taking care of physicians.

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The health system’s mission statement was focused on being the first and best place for patients to choose to receive their care. Dr. Rissmiller suggested Atrium Health also should be the first and best place for physicians to choose to care for their patients. It was the start of focusing on ways to reduce physician burnout and improve well-being.

Scott Rissmiller, MD
Scott Rissmiller, MD

“If you look at where we have been in health care over the past several decades, we had a physician burnout issue before we had the COVID-19 pandemic. And as we all know, the past several years of going through COVID has only intensified the burnout physicians have experienced,” said Dr. Rissmiller, an internist and also enterprise executive vice president for Atrium Health, a Charlotte, North Carolina-based nonprofit health system with over 4,000 employed physicians serving patients at 40 hospitals and more than 1,400 care locations in the Tarheel State as well as South Carolina, Georgia and Alabama.

“We can’t take the best care of our patients unless we take the best care of ourselves and each other,” said Suzanna Fox, MD, enterprise women’s care service line leader and enterprise deputy chief physician executive for Atrium Health. “There is a gap in how we take care of ourselves and how we take care of each other. And we also know that recruitment, but especially retention, of the very best talent that stays in the organization is affected if we don’t prioritize our clinicians’ well-being.”

“People may come for the money, but they stay for the people. We want to make the people a real reason for our clinicians to stay,” said Dr. Fox. “So, creating a culture of  collegiality, trust, and support … and knowing that you have the  support of the healthcare system to lean on makes all the difference in the world.”

Here are some of the ways Atrium Health has placed physician well-being front and center in an effort to reduce burnout.

“The year prior to me coming into this role, our physicians were in the low 40th percentile” for well-being, said Dr. Rissmiller. “After a year of us putting these things in place, we went from the low 40s to over the 75th percentile.

“That was almost an unprecedented increase in one year. And it really was from the communication we put in place,” he added.

Choosing to work with the AMA to survey about burnout (PDF) “was an easy decision,” said Dr. Fox. “We know that the AMA has an amazing reputation in the work that they do, and burnout is a significant priority for the AMA.

Suzanna Fox, MD
Suzanna Fox, MD

“The AMA is also very wide-reaching, so we know we can work with the AMA and learn a lot from them,” she said. “Obviously, we make decisions based on what we know, but there are best practices all over the country that we love to glean information from.

“We’ve also been very impressed with the Joy in Medicine™ Health System Recognition Program that the AMA has and so with that national reputation, we really wanted to learn from other health care systems and learn from the great reputation that the AMA has.”

“We’re planning for the first survey to go out before the end of this year. The organizational biopsy [PDF] will finish sometime before the end of 2022,” said Dr. Fox. “We really want to understand from our physicians what it is that keeps them up at night, where we can help and what the things are that we haven’t thought of.

“We’re really looking at what the administrative burdens are that we can help with, what are the sort of little things that we can take off their plates that will make their lives a little bit easier, such as the inbox in the EMR,” she said, emphasizing that the survey will help them to “really hear what they need and we can tailor our actions to their responses.”

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

And with far too many U.S. physicians experiencing burnout, the AMA has resources that prioritize well-being and highlight workflow changes so doctors can focus on what matters—patient care.

Four years ago, Atrium Health launched an effort called the “Best Place to Care Initiative,” which focuses on removing systemic obstacles that get in the way of physicians caring for their patients.

“Our goal has really been to focus on removing those small things and removing them in a way that we communicate back what we’ve done very clearly,” Dr. Rissmiller said.

“Once you remove one small thing that gets in between them and the patient, you move on to the next one,” he said. “It’s a grassroots effort where we actively seek out from our clinicians those friction points that get in their way so that we can then address them.”

“We just changed our EMR and that has been one of the biggest challenges. Not only learning a new EMR system, but the inbox is challenging,” said Dr. Fox. “It’s challenging across the country, so looking at ways to really hear from physicians what they need that we can help with.”

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One of three main focuses of the Best Place to Care initiative is improving workflow efficiency, which means “maximizing the clinicians’ time with the patient by improving things like the EMR experience removing unnecessary tasks.”

“One of the things I said very early on was I wanted us to get to a place where a physician never had to fill out another form, that all they had to do was sign it,” Dr. Rissmiller explained. “And we have built processes in place now for centralization of form completion, so that the clinicians don’t have to do those unnecessary tasks.

“Then, really focusing on making sure that they have the adequate staff in place, which has now become a significant challenge across the nation, in regard to staffing shortages,” he added.

The second element of the Best Place to Care initiative deals with improving the experience of physicians and other health professionals who help deliver care. That encompasses “the flow in the office, de-hassles of the system and processes, those types of things,” Dr. Rissmiller said. It also includes “streamlining credentialling and the privileging process.”

Sadly, simply keeping doctors and health professionals physically safe has become part of the job.

“We all know and have heard about the rise in mistreatment of clinicians by patients and others, and safety has become a major issue,” Dr. Rissmiller said. “One thing we did about that earlier in the year was really taking a hard look at the response from our clinicians at the things we had in place to protect them in our over 600 clinics and came back with many things that we could do to improve the safety in our offices and immediately executed on those.”

Drs. Rissmiller and Fox and their colleagues also took steps to demonstrate appreciation of physicians and health professionals. One small example involves improved communication.

“When COVID started, I started something called the ‘Daily Brief,’ which is something that was sent out to all physicians, and it has expanded over the last two years and now goes out to about 12,000 people, because it’s been forwarded so many times,” Dr. Fox said.

“It was the source of truth—the good, bad and ugly of where we were with personal protective equipment, number of patients, treatment options, vaccines and other things that came along,” she explained. “I sent it out every day, seven days a week for close to two years. Over , the last six months I send it out once or twice a week depending on the information that needs to be distributed. .

“That sort of open communication has been huge for people,” Dr. Fox said.

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In 2021, as COVID-19 strained the nation’s doctors, Atrium Health stepped up and received the silver designation from the Joy in Medicine Health System Recognition Program.

“We were very proud to get the silver award. I’m very competitive and it’s because we want to be the best and this is the most important work that we do,” Dr. Fox said, adding that “we will apply for the gold membership in 2023.”

Dr. Rissmiller was, at first, more circumspect about seeking external recognition, but his attitude has softened.

“I’ll be honest. When we first kicked off this work almost four years ago, people were like ‘we need to go after these awards’ and I was less excited about that,” said Dr. Rissmiller, who thought “I would rather just do the work that we know is in front of us.”

“I was wrong about how important that was, actually, to our teammates and to our clinicians, to see that not only is the work that they’re experiencing impacting their lives in a real way, but that it is recognized at a national level for being different from what others are doing across the nation,” he said. “So, I was wrong in underestimating the impact of the award. It’s important to do the work, but it’s also very important to be recognized for it and to know that we are on the right track.”

Applications for 2023 recognition will open Jan. 20. Interested organizations will need to complete a self-assessment and attestation, according to program criteria. To learn more about applying, organizations can submit an intent to apply form to get more information and updates. Also, email [email protected] for more on the Joy in Medicine Recognition Program (PDF).

The AMA Physician Well-being Program offers physicians and health systems a choice of cutting-edge tools, information and resources to help rekindle a joy in medicine. By focusing on factors causing burnout at the system level, the AMA assesses an organization’s well-being (PDF) and offers guidance and targeted solutions to support physician well-being and satisfaction.

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