Reducing physician burnout involves many strategies, but the most common solution has been to adopt new technology that improves efficiency and eases doctors’ administrative burdens. Examples include the use of ambient AI tech that can save doctors up to an hour a day.
Yet even as physicians have quickly gained greater access to technology that saves time and effort, burnout rates have not dropped as quickly as hoped, according to R. John Sawyer, PhD, a neuropsychologist who works in the office of well-being at Ochsner Health.
Ochsner Health is a member of the AMA Health System Program, which provides enterprise solutions to equip leadership, physicians and care teams with resources to help drive the future of medicine.
In his role as medical director of professional staff experience at Ochsner’s Office of Professional Well-Being, Sawyer works with physicians and clinical teams struggling with burnout and job stress.
“The minutes saved with new technology tools are not enough to counterbalance the avalanche of new tasks constantly added to a doctor’s day. Put simply, helping doctors click faster won’t completely dig us out of the burnout crisis,” Sawyer said in an interview. “Addressing this challenge requires us to clearly face two realities in this current era of medical practice.”
Those realities, explained Sawyer, are that there is a looming shortage of physicians unlikely to abate anytime soon; and that the younger generation of physicians are vocal about needing improved work-life balance.
Looking at the state of physician burnout in the U.S., health care is in a “treading-water-to-survive kind of place,” said Sawyer. “That’s not a good deal for physicians. They make such an impact on the world but often feel like they’re surviving at work.”
He also noted there is a pressing need to help physicians feel like they’re thriving at work and life.
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™.
Out of sight, out of mind
“One of the things that physicians talk about the most is that the EMR is a big source of burnout,” Sawyer said. “No one would go back to paper charts, so what’s the issue there?”
Sawyer believes that because the technology is always on, physicians must set boundaries.
“The technology is great, but it also requires us to opt out,” he said. “It doesn’t require us to opt in like a paper chart where you walk to the filing cabinet, pick it up and look at it.”
“Your phone is always in your pocket, the chart’s always in your face or on the computer, so that is a lot of technology that physicians are exposed to,” Sawyer said. “If we factor in the personality of a physician—which is to solve problems and help people—the EMR is a constant trigger with a vast sea of problems to solve, all the time.”
That is why it is important to think about how technology reduces the cognitive load of tasks to do. Sawyer recommends that there are certain aspects of messaging that physicians should not manage. Health systems should make unnecessary tasks “out of sight, out of mind” for physicians, so that they don’t have the urge to manage.
For example, Ochsner Health allows physicians to opt out of certain alerts—such as normal lab results or certain questions best handled by nursing staff, as determined by a health system—that don’t need to come to them. This can be accomplished by asking: What categories of information and associated requests are best handled by nonphysician team members?
From there, Sawyer said, health systems can build in workflows and clear expectations about not involving physicians in messages or requests with set criteria. Health systems also need to track how effective the workflow is. This can be done by monitoring how often team members are forwarding messages to physicians.
Sawyer cited medication refills as a case study for how it could work. Ochsner Health has a pharmacy refill clinic that helps manage medication requests.
“At first physicians were nervous about this, but pharmacy managers have been able to manage the refill requests just fine,” said Sawyer. “Ochsner Health found out just how helpful this workflow was when the bypass was turned off temporarily. Doctors were coming to work and had overwhelming inboxes filled with refill requests. We turned the bypass back on quickly.”
“So much of this work was going on in the background that doesn’t even involve doctors, and now they love it because they don’t even think about it,” Sawyer said. He jokes that once that health systems implement this workflow, they will never be able to revert back. “Just try to turn it off once or twice just to remind everyone how much work is being saved.”
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Institutions in this article have been honored by the Joy in Medicine™ Health System Recognition Program.
It takes time for change
Looking beyond refill requests and building workflows where physicians don’t receive unnecessary messages, Sawyer recommended an aggressive approach to change, given that the status quo is not sustainable for doctors and their patients.
“We don’t want to make perfect the enemy of good,” said Sawyer. “So, part of it is starting to try out some approaches and categorizing it, to get things off physicians’ desks.”
For example, in handling patient portal messages, workflows should be unique to different physician specialties.
“There’s a way for AI to categorize messages. Certainly, if there’s some aspect of medical decision-making, then that should be converted from a message to a provider visit,” he said. “I ask physicians to talk to their team about identifying patient requests that will require medical decision-making. If it’s clearly a question that requires a lot of thought on the physician’s part, then they should schedule the patient for a virtual visit or an E-Visit,” which involves the patient answering a branching logic questionnaire in the patient portal, whose answers the provider reviews to make an assessment.
“That way, if the physician really needs to be involved, then they’re going to set up a time to do it that’s actually blocked for patient care,” Sawyer added. “They also should identify situations that a nurse can handle. For example, medication side effect warnings, or unremarkable labs. A nurse knows how to respond to a patient message on those issues.”
“Setting the messaging portal up for success requires a pretty big initial deep dive and then you can start training team members to do it—and not in ways that say we’re adding to your workload,” he said. “Instead, employees can see the value of owning some of the messaging versus the physician.”
Empower physicians to coach
“The most important part—once you build in the workflow—is an accountability piece to make sure it’s being done,” Sawyer said. “Physicians must be able to trust the system to work well without them in all processes.”
Accountability tracking should include tech-based solutions that can detect how many messages are not being forwarded to physicians, how many messages are handled, and so on.
“My experience in working with physicians and their teams is that the individual physician will know—because they’re the closest to that staff member and their patients—to see if these issues are being resolved in a way that works for them,” he explained. “Think about how you equip the physician to lead really well and coach in a way that makes them effective at leading.”
“The biggest solution is for health systems to empower individual physicians to coach and manage some of their staff, and to understand data tracking,” Sawyer said. “A successful physician-led team requires that a physician is skilled at giving feedback and coaching. Once this happens, then the physician can really be okay with “out of sight, out of mind” since they trust their team to handle it well.”
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