The following is a guest post from athenahealth's CEO, President Jonathan Bush.
Today, awkwardly wedged between Manatee Appreciation Day and National Tater Day, is National Doctors Day. In a tradition stretching back to the 1930s, people send cards to their doctors expressing thanks for their hard work and contributions to the health of families and communities.
It was my uncle, President George H.W. Bush, who proclaimed this day of commemoration back in 1991. He singled out in his proclamation “hard work, stress, and sacrifice,” and wrote about how most physicians “endure long and unpredictable hours, and many must cope with the conflicting demands of work and family life.”
If only we could say things have improved, or that 25-plus years of well-meaning Hallmark greetings have translated into real change.
The reality is that for many of our nation’s doctors the hard work has only gotten harder, the stress less manageable and the sacrifice costlier. A recent analysis of billing and EHR data from roughly 40 million primary care visits on athenahealth’s network shows that between 2010 and 2105 alone the average work performed per visit increased by 6%, with a comparable uptick in the number and complexity of diagnoses. But that doesn’t begin to cover the whole picture. We also know from our data that just 60% of the average physician’s time per year is actually spent seeing patients and documenting care. The rest? Reviewing 3,700 administrative documents, documenting and reporting 1,300 quality measures, tracking down 420 missing lab results and 180 missing imaging orders.
This mounting burden comes at a time when physician burnout has emerged as what psychiatrist Steve Adelman has labeled an “occupational health crisis.” Over half of physicians, according to a 2015 Mayo Clinic study, reported feeling emotionally exhausted and ineffective. And consolidation trends show doctors increasingly choosing to sell their practices to hospitals in return for the promise of a steady paycheck and regular hours.
Faced with this occupational crisis, what can be done? How can doctors find joy in medicine again?
One answer is to do far more to support the capability of physicians – and other staff – to serve the needs of patients. This means intentionally redesigning their jobs so they’re engaged, satisfied and productive in their roles. Building physician capability starts with unloading the 40% of work that bogs them down and distracts from their core purpose. Much of this work – like medical claim submission or closing the loop on orders – is the kind of administrivia that in other industries (AirBnB, Amazon) would be offloaded to the internet where it can automated and dispatched at scale.
Next up for overhaul is the capture and reporting of quality measures – an ever-rising burden under MIPS and alternative payment models. As part of recent research on the habits of high-performing practices, athenahealth found that the top clinical performers on our network set up protocols to delegate quality measure capture and reporting to clinical staff. As one practice administrator said of their doctors, “some of them don’t even recognize that they’re fulfilling these requirements.” They’re busy delivering care – and they’re seeing improved outcomes as a result.
Instead of writing thank-you notes today (which, sadly, for most doctors would just add to the after-hours paperwork pile!), here are a few meaningful steps key players in the system can take to put a dent in doctors’ workload and stress.
- Health system leaders responsible for the happiness and productivity of their doctors need to build up and support their capability. They can invest in developing physician leadership (which research shows boosts engagement) and rethink job design and workflows surrounding physicians and staff to ensure the right person is always doing the right work. I was heartened to see a commitment made to these ideas just two days ago by a number of prominent health system CEOs.
- As they implement the MACRA rule with MIPS and APMs, the government needs to minimize the tax these programs impose on doctors as well as the constraints placed on innovation. Too much of physicians’ precious time and energy is spent figuring out dizzyingly complex payment models – and how to jump through ever narrower hoops – rather than innovating care delivery.
- Health IT technology should serve as the enabling platform for the overworked physician, stripping away non-essential information, steering work to the right care team member, surfacing clinical insights at the point of care, and so on. Vendors need to do way better. The good news is that the HIT subsidies have dried up so now vendors must compete over who can out-serve and out-delight physicians.
If they’re freed from some of the burdens that weigh them down, doctors can become more engaged, more productive, and more capable. The impact of this on the health of our country could be profound. So yes, let’s thank doctors today, but to truly honor them let’s do much more.