Improving physician well-being has been at the heart of the work of Makrina Shanbour, MD, for more than a decade. As an internist and the director of provider experience at Confluence Health and Wenatchee Valley Medical Group, Dr. Shanbour was a pioneer in this space, launching the health system’s formal well-being initiatives in 2012, well before physician burnout became a national conversation.
“My biggest passion is to make sure people feel seen, appreciated and supported,” she said during an AMA Insight Network webinar on lessons from leaders about physician well-being.
After the COVID-19 public health emergency cast a glaring spotlight on physician burnout nationwide, Confluence Health deepened its work in 2021 by joining the AMA Health System Member Program, which provides enterprise solutions to equip leadership, physicians and care teams with resources to help drive the future of medicine.
Working with the AMA provided Dr. Shanbour with more robust tools and resources to further advance physician well-being and reduce burnout across the organization.
Over the years, Dr. Shanbour led initiatives that reduce physician burnout and intentionally built a culture around well-being. Those efforts, and the measurable improvements in physician satisfaction that followed, have helped establish Confluence Health as a community system leader in this space.
In 2025, through this work, Confluence Health earned Gold-level recognition from the AMA Joy in Medicine® Health System Recognition Program, which empowers health systems to reduce burnout and build well-being so that physicians and their patients can thrive.
Dr. Shanbour is proud of this recognition, but she has no intention of taking her foot off the gas now.
“I want to continue to go forward,” she said. “We put in a renewed effort to connect with the people we lead, and we want them to do well. Every activity and initiative we do is [designed] to help our people thrive.”
She continues to build partnerships across Confluence Health to address both the tangible and intangible drivers of physician well-being, from reducing EHR burdens to helping doctors feel valued and supported in their professional growth.
Addressing EHR fatigue
Rife with documentation and clerical burdens, complex usability, electronic messaging management, time demands and cognitive load, the EHR is a leading cause of physician burnout nationwide.
Consequently, Dr. Shanbour has spent the last decade identifying ways to improve the EHR experience for physicians across Confluence Health’s ecosystem.
Confluence Health relies on two assessment tools to gauge physician well-being. The first is the AMA’s Organizational Biopsy®, which evaluates organizational culture, practice efficiency, self-care and retention. The second is the Arch Collaborative EHR Satisfaction and Wellness survey, which measures strengths and opportunities related to an organization’s EHR experience.
Across both assessments, one finding stood out: overwork and physician burnout were heavily driven by electronic patient messages and other EHR-related tasks.
To address this, Dr. Shanbour began chipping away at the EHR burden in 2017, when she launched Epic optimization teams. These teams focused on streamlining and improving the EHR experience. They partnered with individual departments to address distinct departmental challenges. While the work helped build momentum and surface common themes, organization-wide progress was slow.
That began to change in 2020, when Beckett Mahnke, MD, joined Confluence Health as the system’s chief medical informatics officer. The Epic optimization work laid the foundation for Dr. Mahnke and Dr. Shanbour to join forces to develop coordinated, data-driven improvements.
“Our work really took off when I partnered with Dr. Mahnke about five years ago,” Dr. Shanbour said. “We were able to see how the projects [to optimize the] EHR can be really effective at improving the lives of our people.”
Together, Dr. Shanbour and Dr. Mahnke began analyzing survey data and developing targeted action plans.
“Dr. Mahnke has been really helpful at making data meaningful so we can use it to take action and make a difference,” she said.
Using data to surface issues
One of the system’s most significant successes has been in addressing the overwork and burnout associated with electronic messages from patients.
When a department struggled to manage its high volume of MyChart messages, Dr. Shanbour and her team did a deep dive into data across the organization to understand how different departments managed this work.
The variation across departments was striking. In some departments, only 19% of the messages were answered independently by staff without physician or nonphysician provider involvement. In other departments, staff answered 90% of the messages. On average, about 60% of MyChart messages were handled by staff vs. physicians and nonphysician providers.
Armed with these insights, Dr. Shanbour and her team recognized that improving physician well-being and creating consistency across departments required clear policies, procedures and workflows. The goal was to ensure staff handled more nonclinical messages, easing the heavy administrative burden on physicians and care teams.
From AI implementation to digital health adoption and EHR usability, the AMA is fighting to make technology work for physicians, ensuring that it is an asset to doctors. That includes recently launching the AMA Center for Digital Health and AI to give physicians a powerful voice in shaping how AI and other digital tools are harnessed to improve the patient and clinician experience.
Driving improvements, seeing results
Dr. Shanbour and her team partnered with departments to identify best practices, and shared those procedures and flowsheets throughout the entire organization.
The results have been promising thus far.
In fact, over the past year, Confluence Health has increased staff handling of MyChart messages from 48% to 59% across the organization. These efforts also led to improved policies and procedures related to message management. Primary care physicians have reduced their total time in the EHR by 34 minutes per day due to the overarching strategy employed by the team.
This is just one of several Confluence Health initiatives underway to improve the EHR experience for physicians and other health professionals. And it’s paid off.
Today, Confluence Health is setting the standard for EHR satisfaction for community hospital systems across the country. Specifically, results from a Confluence Health survey show that the system moved from near the 20th percentile five years ago into the 100th percentile last year compared to other community hospital systems nationwide.
“This [survey shows] how well our people are working with the EHR and how they feel about their experience,” Dr. Shanbour said. “It is a huge win and a real testament to the teamwork that's gone into this effort to make the EHR better for our people.”
Helping physicians feel valued
Confluence Health applies a similar data-driven approach to addressing other, often more intangible, aspects of physician satisfaction, engagement and well-being.
For example, by tracking physician turnover rates, Confluence Health recognized a steady increase in turnover rates since the COVID-19 public health emergency. To address this, Dr. Shanbour established a subcommittee focused exclusively on physician retention.
Through the committee, physicians were interviewed, “which gave us insight into what we can do to help people stay,” she said. “Using that data helped us develop strategies that can make a difference.”
One key retention strategy focuses on developing, training and supporting physician leaders, providing more robust communication pathways and opportunities for recognition.
Investing in physician leaders delivers multiple benefits. Physician leaders gain opportunities for professional growth and development, which gives them a strong sense of agency, pride and confidence. It also connects them more deeply to Confluence Health’s strategic vision and values.
“Having joy and pride in our work is one of the values of the organization,” Dr. Shanbour said. “Tying physician well-being into that organizational goal … has been really valuable.”
These benefits also extend beyond the leaders and to the teams they lead.
“We see how improving our physician leaders’ skills makes a huge impact on the people they’re leading,” Dr. Shanbour said. “Empowering the people they’re leading is one of the most important jobs of a leader.”
Together, these efforts have helped physicians and their teams at Confluence Health feel more seen, supported and appreciated, which are all crucial for improving retention, prioritizing well-being and reducing burnout across the board.
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