Save the free pizza, standing ovations, and primo parking spaces. If employers want to improve physician burnout, a new study suggests that they should limit after-hours charting, and provide better EHR training.
Anecdotally, we all know EHRs take a toll on physicians. Now, thanks to a new study published in the Journal of the American Medical Informatics Association (JAMIA), we can quantify the problem and provide better direction for remedying it.
May was Mental Health Awareness Month, and with that, we turn our attention to physician mental health, specifically burnout. January 2020 began with some good news from the American Medical Association (AMA). An AMA survey indicated an overall physician burnout rate of 42%, a decline from 46% five years prior. Then, along came a pandemic. A September 2020 meta-analysis published in Healthcare found that the pandemic compounded already existing physician challenges, including increased workload, “which is directly correlated with increased burnout.” The researchers noted that exposure to COVID-19 patients “does not necessarily correlate with increased burnout and is an area for more research.”
‘Single worst factor’
At this point, it’s undeniable that EHRs have increased physician workload. So much so that several of our readers wrote to us about it. We published, Is It Better to Be a Doctor Now Than It Was 50 Years Ago?, almost a year ago and it continues to get responses from physicians. (Still want to weigh in? Write me.) Here are a few comments we’ve received:
“The single WORST factor that has ruined medical practice is the EMR. … Each hour of face-to-face time with a patient also means at least an hour of charting, mainly irrelevant checking off boxes and other tedious measures such as a full 14-point ROS.” — (Editor’s note: This physician gave us permission to use their name for attribution, however, after they told us, “Our institutional culture is punitive and rules by fear and intimidation,” we decided not to publish it.)
“I left medicine in 2012 due to the electronic medical record. During my time in medicine, burnout was never an issue. Sure, I had medical school debt to repay, but this was done easily and with no real stress.” — Thomas T. Reiley, MD
50 years ago, “(We) did not need EHRs, insurance companies did not tell us how to practice medicine, pharmacy corporations did not limit what drugs we could use, and we were self-employed and not part of megalithic hospital corporations.” — Steven Emmett, DO
These are just some of the responses. There are at least a dozen highly detailed ones as lengthy as typical PhysicianSense posts. (Which reminds us, we publish physician opinions. If you have something you want to say, contact us and we’ll send you the parameters.)
Send in the support
The JAMIA study shows doctors have cause to complain. Researchers found that post-work charting is significantly associated with physician burnout. For example, doctors who spent 5 or fewer hours weekly on after-hours charting were more likely to say they had lower burnout levels. Self-reported burnout becomes more likely as after-hours charting ticks upward, the researchers said. Additionally, EHR support was also significantly associated with lower levels of burnout—independent of after-hours charting.
Researchers queried more than 25,000 American physicians from 213 organizations across the United States. Among the respondents:
Researchers found that doctors who said they performed 0-5 post-work hours of charting were twice as likely to report lower levels of burnout than those who logged 6 or more charting hours after work.
“The likelihood of experiencing symptoms of burnout became more common with each increase in time spent on after-hours charting, with the largest jump occurring between 0–5 hours and 6–15 hours,” researchers wrote.
Perhaps not surprisingly to you, the researchers found that organizational EHR support, such as training and IT support, correlates to less self-reported burnout. Physicians were presented with the following statement: “Our organization has done a great job of implementing, training on, and supporting the EHR.” They were then asked to rate the statement on a scale of 1-5, with 1 representing strongly disagree and 5 strongly agree.
9%: Strongly agree
12%: Strongly disagree
The data indicate that doctors who think their employer excelled at EHR implementation, support, and training are twice as likely to report lower levels of burnout, compared with those who disagree.
“Satisfaction with organizational EHR support was significantly associated with lower levels of burnout overall and for all specialities included in our study, independent of the after-hours charting variable,” the researchers wrote. “While the organizational EHR support measurement has not been used in prior literature, previous studies have reported that organizational IT improvements can reduce burnout symptoms.”
Burnout by specialty
The study also revealed patterns in burnout levels by specialty. The specialties with the highest levels of burnout were:
Those with the lowest levels of burnout included:
“The overall self-reported burnout in our study is similar to what was found in previous smaller-scale studies examining the relationship between after-hours charting and self-reported burnout,” researchers wrote.
A recent study shows that increases in after-hours charting correlate with higher levels of self-reported physician burnout.
The same study also shows that increased perceptions of EHR support are correlated with lower levels of self-reported physician burnout.
Furthermore, the study findings on burnout levels among various specialties are aligned with other findings on the topic.