By Ken Congdon
Over the past few weeks, several articles have emerged citing the troubling physician burnout statistics revealed by the 2015 Medscape Physician Lifestyle Report (see the Infographic included in this article). In short, 46% of all physicians surveyed say they are burned out. This represents a nearly seven percent increase in physician burnout rates since Medscape last conducted this survey in 2013.
There are several factors contributing to the rise in physician burnout — everything from insufficient income due to reimbursement cuts to doctors spending too much time at work. However, when you look closely at the data, one can’t help but recognize the negative impact the drive towards IT adoption is having on physician burnout.
The Trouble With Health IT
In some instances, this is clearly outlined in the report. For example, the “increased computerization of the practice” was cited as the fourth most significant contributor to physician burnout in this year’s Medscape report, moving up from a ninth place finish in the 2013 study. Seventy percent of physicians surveyed this year said that EHR technology decreased their face-to-face time with patients, and 57% noted that it detracted from their ability to see patients. Furthermore, according to a 2014 Physicians Foundation survey, although 85% of physicians have now implemented an EHR, only 32% say the technology has improved the practice, and 46% say the software has detracted from efficiency.
Assuming this EHR-specific data is accurate, consider the role technology initiatives could be playing in other top-cited causes of physician burnout. For example, “too many bureaucratic tasks” was identified as the top cause of physician burnout by respondents to the Medscape survey. While these bureaucratic tasks include things like billing, obtaining insurance approvals, financial and personnel management, and negotiating contracts, many IT-related administrative tasks also factor into this category. Take, for instance, the stringent reporting requirements necessary to successfully attest for Meaningful Use (MU) or the technology infrastructure changes necessary to comply with new HIPAA requirements or ICD-10.
It’s likely that EHR technology is also contributing to physicians “spending too much time at work,” the second most significant cause of burnout according to the Medscape survey. For example, if EHR software is truly making 46% of physicians less efficient, it’s likely these doctors are putting in more hours at the office to catch up on tasks the technology may be impeding. Clinical workflow disruptions created by the software are largely to blame here. I’ve interviewed several physicians who absolutely detest the data entry requirements imposed on them as a result of EHR technology. These doctors don’t have particularly strong keyboarding skills and they find the act of CPOE to be a slow, painstaking process that detracts from patient interaction. As a result, many of these physicians revert to their old paper-based documentation practices during physical patient exams and then enter this data into the EHR at the end of their shift. This not only creates extra work for the physician, but can also introduce data errors and inaccuracies.
Other Factors Leading To Physician Burnout
Now, it’s not entirely fair or accurate to place all (or even most) of the blame on the EHR software itself. There are numerous other factors related to technology adoption that are adding to physician stress. For example, change management is a huge part of the problem. Physicians need time to become comfortable and proficient using new technology. At the same time, much of the EHR technology in use today needs to get better at mirroring existing physician workflows. Another issue is bad timing. There are a slew of changes and new requirements hitting physicians at the same time. Doctors aren’t just being forced to deal with technology adoption, they are also trying to meet emerging ACA provisions, prepare for the upcoming transition to the ICD-10 coding standard, and grapple with reimbursement changes. With all of these high-level (non-patient centered) initiatives on their plates, IT adoption is often viewed by physicians as just another administrative nuisance rather than a potentially powerful tool in improving their performance and patient care.
That being said, most physicians I speak with do see promise in health IT adoption, they just oppose the prescribed way in which it is being implemented and feel EHR technology still needs to evolve. “There is definitely potential in health IT, but the mandates that come along with this technology [such as MU], are wearing doctors down,” says Dr. Linda Girgis, family practitioner in South River, NJ and author of Inside Our Broken Healthcare System. “Additionally, much of the EHR software on the market today is not yet able to deliver on the promises that have been preached to physicians over the years. For example, interoperability continues to elude the market, limiting the technology’s usefulness. EHR technology has a long way to go before it adds value to our practice flow and helps us improve clinical outcomes.”
Health IT Is A Necessary Evil
So, are physicians better off without health IT? Many would say so, but from where I sit, the answer to that question is a resounding “no.” As painful as it may be, MU (at least initially) was necessary to motivate IT adoption. Without it, physician adoption of EHR technology would likely still be hovering around the 50% mark rather than the nearly 80% adoption rate we see today.
True, when assessed collectively, EHR technology is not yet where it needs to be to be viewed as an indispensable clinical tool by physicians. However, the technology is improving every day. Moreover, physicians throughout the country are becoming more and more adept at working in a digital world as time passes. This trend was validated by the Medscape survey, with 81% of respondents saying that they are becoming more comfortable with their EHRs. Soon, the technology barriers that physicians see as burdensome today will be removed and replaced with newfound operational efficiencies, data accuracy, and clinical insight. That’s not to say we won’t lose several physicians to retirement along the way, but those that remain will be well armed to leverage technology to its fullest to usher in Triple Aim.
Medscape's Physician Lifestyle Report 2015