Becoming a doctor is not easy. And these days, staying a doctor can be just as difficult. The daily demands placed on physicians in nearly every medical and surgical specialty are increasingly linked to a condition known as physician burnout. Unlike stress, physician burnout sufferers are not able to recover during their time off which in turn leads to physical and emotional exhaustion – and unfortunately, this troubling consequence is not rare.
Numerous global studies indicate that approximately 1 in 3 doctors are experiencing burnout at any given time; some more recent studies indicate that the prevalence of physician burnout is as high as 60%. Many scholarly articles have gone as far to describe burnout as an “epidemic,” with professional medical societies taking the issue on at annual meetings in order to stem the potential loss of physicians from practice.
So, why are so many physicians experiencing burnout? There are several factors that contribute, but in the hospital setting the most significant issue is excessive workload – too many patient encounters and not enough time. In fact, one study estimates that 40% of hospitalists, who are typically on the front line of acute care, reported having an unsafe workload at least once a month.
The result of burned out physicians who are assigned an unsafe workload include poor patient satisfaction and outcomes with a direct impact on 30 day readmissions. Case in point: 14% of hospitalists surveyed reported an increase in 30 day readmissions due to suboptimal planning and other factors related to an excessive patient workload.
More Complicated Than Meets the Eye
And what are the consequences of an excessive workload? Many of the drivers that are tied to readmissions including diagnostic errors and premature discharge. So given tools such as electronic medical records at the physician’s disposal, and multi-pronged programs seeking to enhance both physician engagement and patient satisfaction (not to mention the fact that reimbursement is now tied to this latter measure), how do high workloads even happen in this day and age? Generally, hospitalized patients are distributed for daily medical care via assignment to hospitalists who are on service, covering patients on a medical floor. If there are 48 admitted patients and three hospitalists working, each hospitalist would be given responsibility for 16 patients.
However, the problem with this approach is that all patients are not the same. Some patients require much more time and effort than others creating a workload imbalance to the point that some workloads are unsafe. Additionally, when a provider feels s/he is consistently given a roster that is more labor and time intensive than his or her peers, that provider will start to feel frustration that over time can evolve into burnout.
Unsafe workloads can also have an impact on length of stay (LOS). Case in point, research published in a 2014 issue of JAMA Internal Medicine which found that LOS increased along with workload, particularly in hospitals with less than 75% occupancy where LOS increased linearly from 5.5 days to 7.5 days across low to high workload levels. The estimated net result? Nearly $7500 of additional cost per admission.
Applying Automation for Fair Distribution
Understanding that workload is a critical factor around patient outcomes, cost of care and provider satisfaction, MedAptus’ created Assign which uses a configurable protocol engine to optimally match caregivers, such as hospitalists, to patients. With Assign, each admitted patient is given weight based several factors that impact physician time and effort, and this is calculated along with the capacity of each provider on service. These factors, processed through Assign’s protocol engine, allow workload to be fairly distributed, significantly reducing the chances of unsafe workload assignments.
As one example of how this might work, patients who are approaching discharge and thus have stable vital signs and in-range lab values will require less effort from a physician than a newly admitted patient that has severe pain, problematic vital signs and has yet to receive a diagnosis. So, while one provider may be aligned with 11 patients and the other 14, the workload involved with both census’ is equitable.
Another benefit of the Assign technology is the potential to establish a “PCP in the hospital.” Beyond aiding with workload balancing, the software also helps maintain continuity of care within an admission and between admissions. If a patient with a chronic condition is able to form a relationship with a hospitalist, and that physician is given the opportunity to learn more about the patient’s home life, medical history, and so forth, there is better chance for compliance which can range from medication adherence to follow-up with the actual PCP. Taking this a step further, patients can even be assigned based on their PCP so that over time, the key medical contacts in both the acute and office settings can team on approaches to keep the patient out of the hospital.
In medicine, nothing is simple, and there are few islands. Burnout is a complex phenomenon just as re-admissions are multi-factor and often simply not avoidable. On the surface, it might not be obvious that a provider who is unhappy and feeling negative about his/her chosen profession may be making decisions that impact a patient down the line. But by understanding the most prominent feature of a provider’s burnout, with significant evidence pointing to workload, an effective solution could be just cloud-based software away.