Physician Health

These 4 workflow changes help cut burnout by 45%

Sara Berg, MS , News Editor

Physician burnout is a widespread problem among primary care doctors. To address this, an academic general medicine clinic in San Francisco aimed to change faculty perceptions of burnout and work-life balance. By creating an efficient health care workflow, this academic clinic saw a 45% reduction in physician burnout. 

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.

The AMA’s STEPS Forward™ open-access modules offer innovative strategies that allow physicians and their staff to thrive in the new health care environment. These courses can help you prevent physician burnout, create the organizational foundation for joy in medicine, create a strong team culture and improve practice efficiency. One set of CME modules specifically addresses workflow and process

STEPS Forward is part of the AMA Ed Hub™, an online platform that brings together all the high-quality CME, maintenance of certification, and educational content you need—in one place—with activities relevant to you, automated credit tracking and reporting for some states and specialty boards. 

At the University of California San Francisco (UCSF), the Division of General Internal Medicine completed the Mini Z burnout survey. Compared with other academic general internal medicine divisions, UCSF physicians reported higher burnout (56% versus 33%) and stress (88% versus 65%), according to a Journal of General Internal Medicine study co-written by Jon Lee, MD, Mitchell D. Feldman, MD, MPhil, chief of the Division of General Internal Medicine at UCSF, and AMA member Mark Linzer, MD, an internist and director of general internal medicine at Hennepin County Medical Center in Minneapolis.

“Even before the changes led to a concrete improvement or change, and the physician or provider experience, just the fact that we’re engaged in a change process can also improve morale and burnout because there’s a sense that we’re moving in the right direction,” said Dr. Feldman.

Executive leadership implemented a set of workflow changes that reduced burnout from 56% to 31% and stress from 88% to 63%. These are the updates they made.

On average, when a patient called the practice, that message was touched seven times before it was resolved, requiring several days to complete. As a result, patients would call again because they were not getting a response, leading to duplicate messages.

“We created a one-touch team with the goal of resolving 50% of incoming phone calls on first touch. We’ve been able to do that from day one of this one touch team,” Dr. Feldman said.

Nurse practitioners were hired to help with in-basket management and coverage for physicians who were out of the office. These nurses will check the physician’s inbox to see if a patient needs to be called back or what else can be handled during the day.

“It’s helping to reduce some of the inbox work so that there’s less at the end of the day—the ‘pajama time,’” said Dr. Feldman. 

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Adding two administrative “desktop” slots created time for documentation and in-basket management during the clinic day. To do this, one appointment in the day was removed and a clinical desktop slot substituted for clerical work. Reducing the volume expectations for busier doctors helped to reduce work after work for these physicians. 

To create more cohesive clinical teams, the division moved to a new system of clinic “flow.” This allowed the medical assistant or licensed vocational nurse “flow managers” to take on new responsibilities such as agenda setting. These flow managers also helped to address the “grains of sand,” which are inbox messages checked and resolved in between patient visits.

Prior to the 2019 American Conference on Physician Health™(ACPH), the AMA will be hosting a practice transformation boot camp. The boot camp has been designed to focus on the fundamentals of effective change strategies and workflow interventions that improve practice efficiency and promote professional well-being. Physicians, care team members and other health system professionals are invited to register.

Registration for the AMA-led boot camp and the ACPH—a scientific conference co-sponsored by the AMA, Mayo Clinic and Stanford University—is now open. This year’s theme for the ACPH is “Activating health system change to promote physician well-being.”