Practice Transformation: Research

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Practice Transformation: Research

As a respected thought leader and convener, the American Medical Association bases its work in practice transformation and professional satisfaction on rigorous research and practice science.

Physician burnout has economic costs as well as financial costs associated with staff turnover, lost revenue, decreased productivity and risks to the organization from lower quality of care and potential for more frequent medical errors.

AMA research has highlighted the system-level issues that drive burnout, and the steps organizations can take to coordinate solutions for effective changes.

Our seminal research on physician burnout has shaped other collective understanding of its underlying causes, drivers of burnout, and the impact burnout has on physicians, patients and health care organizations. In collaboration with health care systems, the AMA’s research efforts are aimed at delivering evidence-based, actionable solutions to increase professional well-being.

Practice transformation

AMA’s work in practice transformation aims to create the conditions where joy, purpose and meaning are possible for physicians and other health professionals.

National burnout survey

The most recent study in this series found that 62.8% of U.S. physicians exhibited at least one symptom of burnout in 2021, compared with 38.2% in 2020, 43.9% in 2017, 54.4% in 2014, and 45.5% in 2011. Learn more.

Career Plans of US Physicians After the First 2 years of the COVID-19 Pandemic

Roughly two of every five U.S. physicians intend to reduce their clinical work hours in the next year, more than double previous rates. These findings have potentially profound implications for the adequacy of a U.S. physician workforce already facing substantial shortages. Learn more.

Politicization of Medical Care, Burnout, and Professionally Conflicting Emotions Among Physicians During COVID-19

In the sample of 2,780 physicians in emergency medicine, critical care, noncritical care hospital medicine, and ambulatory care, stress related to politicization of medical care was reported by 91.8% of physicians. Learn more.

Factors affecting physician professional satisfaction and their implications for patient care, health systems and health policy

This formative report identifies key drivers of professional satisfaction and provides recommendations to reducing burnout. Learn more.

The Association of Work Overload with Burnout and Intent to Leave the Job Across the Healthcare Workforce During COVID-19

In this study of physicians, nurses, and other clinical and non-clinical staff, perceived work overload was associated with burnout and intent to leave across all role types. This evaluation suggests that health care workers (especially nurses and other clinical staff) feel unable to meet what are at present unrealistic demands for productivity and efficiency, with downstream effects on well-being and work intentions. Learn more.

Trends in Clinician Burnout With Associated Mitigating and Aggravating Factors During the COVID-19 Pandemic

In this survey study of U.S. clinicians, burnout increased throughout the pandemic, reaching its highest levels (>60%) late in 2021; intent to leave also reached high levels (>40%) late in 2021. Chaotic workplaces and lack of control of workload were associated with higher burnout, while efficient teamwork and feeling valued were associated with lower burnout. Learn more.

Childcare Stress, Burnout, and Intent to Reduce Hours or Leave the Job During the COVID-19 Pandemic Among US Health Care Workers

In this survey study, high childcare stress was associated with 80% greater odds of burnout in all health care workers. These findings suggest there is an association between reporting high childcare stress and burnout, and programs to reduce childcare stress may be beneficial for workers and health systems. Learn more.

Health Care Expenditures Attributable to Primary Care Physician Overall and Burnout-Related Turnover: A Cross-sectional Analysis

Primary care physician turnover is costly and results in nearly $1 billion in excess health care expenditures. A significant portion of this excess cost, $260 million, is attributable to burnout. Learn more.

Personal and Professional Factors Associated With Work-Life Integration Among US Physicians

This cross-sectional study identified factors associated with work-life integration in physicians and found that lower WLI was reported by physicians who are women, single, aged 35 years or older and who work more hours and call nights. Learn more.

Physician task load and the risk of burnout among U.S. physicians in a national survey

Cognitive task load can affect physicians' ability to perform their job well and may contribute to burnout. Learn more.

Disparities in Burnout and Satisfaction With Work-Life Integration in U.S. Physicians by Gender and Practice Setting

This article explores the interaction between academic practice, private practice and gender in relation to physician burnout and satisfaction with work-life integration and finds that gender differences in rates of burnout are related to practice setting and other differences in physicians' personal and professional lives. Learn more.

Estimating attributable cost of physician burnout

The organizational cost of physician burnout can range from $500,000 to more than $1 million per physician. Learn more.

Professional satisfaction and the career plans of U.S. physicians

This survey research demonstrated nearly 1 in 5 U.S. physicians intend to reduce clinical work hours in the next year, and roughly 1 in 50 intend to leave medicine altogether in the next 2 years to pursue a different career. Learn more.

Allocation of physician time in ambulatory practice: A time motion study in four specialties

For every hour physicians provide direct clinical face time to patients, nearly two additional hours are spent on EHRs and desk work in a clinic day. Learn more.

Research has illustrated that EHRs may largely contribute to physician burnout and frustration. The AMA has partnered with several research teams from around the country to further understand the impact of EHRs on professional satisfaction and to illuminate the promise of objective EHR use metrics to quantify elements of efficiency of practice and teamwork.

Electronic Health Record (EHR) Use Research Grant program

Since 2019, the AMA has invested more than $2 million in research grants through the EHR Use Research Grant program. The grants are awarded annually to multiple health care organizations to support research on EHR-use metrics and their relationship to burnout, professional satisfaction, well-being, and other practice-related factors. Learn more.

Characterizing the Patterns of Electronic Health Record-Integrated Secure Messaging Use: Cross-Sectional Study

This study used metadata on the use of Epic Systems secure chat platform to characterize the use of EHR-integrated secure messaging within a large health system. Secure messaging was found to be widely used by various health care professionals, including nurses, physicians, medical assistants, social workers and inpatient advanced practice providers. Many users interacted with over 20 messages a day and the median response time was 2.4 minutes. This high messaging volume and short response time sheds light on the interruptive nature of secure messaging and its potentially negative impact on clinician workflow, cognition and errors. Learn more.

Identifying and Addressing Barriers to Implementing Core EHR Use Metrics for Ambulatory Care

Precise, reliable, valid metrics that are cost-effective and require reasonable implementation time and effort are needed to drive EHR improvements and decrease EHR burden. Differences exist between research and vendor definitions of metrics. This 2023 Applied Clinical Informatics study identifies actionable solutions to address core categories of EHR metric implementation challenges. Learn more (PDF).

Association of Physician Burnout with Perceived EHR Work Stress and Potentially Actionable Factors

Physicians of all specialties experienced unprecedented stressors during the COVID-19 pandemic, exacerbating preexisting burnout. This study examines burnout’s association with perceived and actionable electronic health record (EHR) workload factors and personal, professional, and organizational characteristics with the goal of identifying levers that can be targeted to address burnout. Learn more.

Metrics for assessing physician activity using EHR audit log data

Published in JAMIA in 2020, authors propose seven core measures of EHR use that reflect multiple dimensions of practice efficiency and use cases of these measures for multiple stakeholders. Authors argue that standardization of EHR use measures will foster cross-study synthesis and comparative research. Learn more.

Perceived EHR usability as a predictor of task load and burnout among U.S. physicians

Published in JMIR in 2020, this investigation found that physician-rated EHR usability was associated with task load, showing that more favorable usability ratings correlated to lower task load and lower odds of burnout. In an Emerging Topic presentation, Cognitive workload: A modifiable contributor to physician burnout?, authors Elizabeth Harry, MD and Christine Sinsky, MD, discuss study findings and approaches that health care organization leaders can take to address system issues to reduce burnout and promote physician well-being. Learn more.

Tethered to the EHR: Primary care physician workload assessment using EHR event log data

This retrospective cohort study, followed by direct observation, found that primary care physicians spend more than one-half of their workday, nearly six hours, interacting with the EHR during and after clinic hours. Learn more.

Association of Perceived Electronic Health Record Usability With Patient Interactions and Work-Life Integration Among US Physicians

This cross-sectional study evaluated positive and negative perceptions of EHR use during patient encounters and at home after work hours. Higher physician-perceived EHR usability was associated with higher levels of perceived positive outcomes such as improved patient care, and lower levels of perceived negative outcomes such as worse patient interactions and work-life integration. The authors propose that EHR usability can be improved, thus improving patient care and physician well-being, if it is made a priority by those who design, implement and regulate EHRs. Learn more.

Characterizing physician EHR use with vendor derived data: a feasibility study and cross-sectional analysis

This study uses EHR audit-log data to determine that for every eight hours of scheduled patient time, ambulatory physicians spend more than five hours in the EHR. Differences in EHR use varied by specialty and physician gender. The analysis also demonstrates that while vendor-derived audit-log data are useful to some degree, their limitations do not allow for derivation of all proposed core EHR metrics and comparison of metrics across vendor products. Learn more.