Provider burnout

As hype grows around artificial intelligence in healthcare, a seemingly paradoxical question is setting off faint warning bells in the minds of skeptics and proponents alike: Could AI tools meant to reduce clinician burden actually increase it?

It’s too soon to say, given the technology’s nascency. But the answer — which has big implications for the future adoption of AI in the industry — depends in part on how intensely clinicians have to fact-check models, along with financial incentives in healthcare’s majority fee-for-service payment infrastructure, according to experts.

All told, AI products could add up to weaker time savings than developers promise, and any time saved could quickly be filled up by additional patient visits as hospitals and medical groups hustle to increase earnings.

“That’s absolutely a worry,” said Graham Walker, the co-director for advanced development at Kaiser Permanente’s medical group, during a panel at the HIMSS healthcare conference in Las Vegas. “The easiest way to get more revenue out of your healthcare system is by telling the doctors and [nurse practitioners] and pharmacists to go faster and see maybe just one more patient.”

‘The tools aren’t perfect’

The goal of many AI tools in healthcare is to reduce administrative friction by helping with rote tasks like documenting patient visits, looking up medical information or filing paperwork. Such tasks contribute to clinician burnout, which is a major problem in the industry and can lead physicians to exit the field.

About one-third of doctors responding to an American Medical Association survey in 2023 said they were interested in or planning to leave their jobs in the next few years. Many cited work overload as the reason: According to some research, healthcare workers spend the majority of their week working on administrative tasks.

Enter AI. Algorithms have been in use by healthcare companies for decades, but excitement around the tech has reached a fever pitch in the past few years with advancements like generative AI, which can create original text, and AI agents, which can perform tasks without human oversight.

A number of companies are folding the technology into sleekly-packaged products, touting time-saving metrics that may almost seem too good to be true to clinicians sick of after-hours ‘pajama time’ spent on documentation.

Abridge, a startup that uses ambient listening and generative AI to automate clinical notetaking, and Nabla, another ambient AI assistant, both claim to save providers about two hours each day.

Software giant Oracle has woven AI into its health records platform for providers, including a clinical AI assistant. Physicians using that tool see a 30% decrease in documentation time, according to the company.

Meanwhile, Microsoft says its AI documentation product saves doctors five minutes on average per patient visit.

“The capabilities that AI scribes bring to the practice of care are remarkable,” said Rohit Chandra, the chief digital officer at the Cleveland Clinic, during a panel. (The academic medical system is currently rolling out an AI documentation software from Ambience across its provider network.)

Documentation products tackle an acute pain point for doctors, while being relatively simple to use, easy to implement and safe, because they’re supervised by clinicians, Chandra said.

However, AI performance metrics such as time saved should be taken with a grain of salt, according to experts.

Clinicians still need to review the AI’s output to catch mistakes. That process, known as ‘human in the loop’, is key to ensure accuracy and build trust in AI, experts say.

Letting AI tools operate unsupervised could result in medical records containing made-up symptoms, or missing information that could be key to a patient’s health.

“That’s where I think we can get into trouble. The technology is going to get to the point where, at least in my opinion, I don’t think we’re going to need to worry as much. But as we think about early adoption, we do have to be cognizant that it is going to make mistakes,” Brenton Hill, head of operations at health AI standards group the Coalition of Health AI, said during a panel.

But deputizing clinicians to police what AI generates can cut significantly into time savings or, in some cases, erase them altogether.

“The tools aren’t perfect,” said Deborah Edberg, a family medicine physician with CVS-owned primary care chain Oak Street Health, during a panel. “We use AI to do our documentation and I do spend quite a bit of time going back and editing ... It can be a bit of a burden to make sure that what is recorded is accurate.”

To date, there have been no extensive, independent reviews of AI scribes in healthcare. But one recent study published in JAMA Network Open found Microsoft’s ambient scribe received mixed feedback from users.

“A recurring theme was the need for substantial editing and proofreading of the AI-generated notes, which sometimes offset the time saved,” the researchers wrote.

Time savings may not reach clinicians

Fee-for-service incentives could also prove a problem. The payment structure, which underpins the majority of healthcare spending in the U.S., rewards providers based on the volume of visits, tests and procedures they perform.

Meanwhile, despite a recovery in operating margins since the COVID-19 pandemic, costs are continuing to rise for hospital operators.

As a result, hospitals and other physician owners are incentivized to stuff their clinicians’ schedules as tightly as possible, to bring in as much revenue as possible. Any time freed up for doctors by AI might be filled with another visit, experts say.

“It could happen. And some organizations want to do that. And from our perspective, that’s an organizational decision,” Rachel Wilkes, the corporate lead for generative AI initiatives at EHR vendor Meditech, said. “If they want to schedule more patients with time savings, they can do that.”

Things that improve the productivity of the healthcare system — like reducing patient no-shows — often result in a heavier visit load for physicians, said Seth Howard, executive vice president of research and development at Epic.

“The conversation between the health system and the doctors need to be, ‘What do we do with those time savings?’ Does it go back into helping the doctor have some flexibility during the day? ... Or for doctors to see more patients?” Howard said.

Vendors are aware that the draw of AI products for hospitals includes the potential to increase revenue. 

Along with saving five minutes per encounter, Microsoft’s ambient AI frees up “13 additional appointment slots per provider, per month,” according to marketing materials.

The need to bolster flagging finances is one reason hospitals are ravenous for the tools, experts say. Demand has been skyrocketing, with the CEO of one company using AI to automate provider workflows likening it to “a fairy tale.”

“Our ambient product went from zero appointments a year two years ago, to a couple hundred thousand last year, to on track for 10 million this year,” said Tanay Tandon, the CEO of Commure, during a panel. “That sort of expansion and usage of AI in healthcare is incredibly exciting. That’s no longer your nerdy technical doctors playing around with it in the corner. This is meaningful use.”

Experts say like with any other technology, there are pros and cons when it comes to AI scribes, assistants and similar tools. In addition, other metrics besides time saved are important to physicians, like reducing their mental load by simplifying tasks or improving their job satisfaction by allowing them to focus on clinical care.

And anecdotal feedback from clinicians has been great, according to tech giants, AI scribes and the EHR vendors weaving the tech into their workflows.

Epic, for example, doesn’t have an average figure for how much time its own ambient documentation tool saves. But according to Howard, “physicians say, very commonly, I could never go back to how I did documentation before.”

An aging population with heightened care needs and lagging labor trends will create a shortage of over 100,000 critical healthcare workers around the close of the decade, according to a study from consultancy Mercer.

Certain states and specialties will weather most of the burden, according to the report. Mercer projects a deficit of 73,000 nursing assistants by 2028 as the field grows by just 0.1% per year.

New York, New Jersey and Tennessee are likely to experience the largest labor shortages across all roles by the same year. Meanwhile California, Pennsylvania and Texas are projected to have a surplus of healthcare workers.

Mercer projects a total supply of 18.6 million healthcare workers in 2028 — and a shortage of over 100,000 to address national health needs. Still, some specialties and geographies are expected to have a surplus of workers.

The nation’s physician and registered nurse populations, for example, are expected to grow modestly until 2028. Both fields are projected to have a surplus of workers nationwide by 2028, with registered nurses anticipated to have a surplus of about 30,000 by 2028.

However, even in growing fields, workers may be scarce in certain geographies. Mercer predicts California, Texas and New York will face deficits of physicians. Pennsylvania, Indiana and Minnesota will have a surplus. Registered nurses will be most scarce in New York, Tennessee and Massachusetts, according to the report.

Some shortages — such as the shortage of nursing assistants — are in part due to some professions growing at more sluggish rates than others.

Nurse practitioners are expected to grow at the fastest annual rate among the occupations reviewed by Mercer, while nursing assistants will grow the slowest. 

While the projected shortage is an area for employers to watch — and consider when developing compensation strategy and technology to support smaller teams — the shortage does not compare to the spike in attrition seen during the COVID-19 pandemic, according to the report.

Healthcare workers reported high rates of burnout following the onset of the COVID-19 pandemic due to increased uncertainty, a rise in workplace violence and increased staffing pressures. Burnout contributed to elevated rates of attrition industry-wide. 

Mercer notes that the field lost 100,000 workers between 2020 and 2022 alone.

To prevent a similar exodus now, employers should manage employee burnout early on to prevent an “endless spiral of attrition” related to burnout, the authors concluded.

“Given that attrition is often driven by burnout, healthcare systems need to ensure the well-being of existing employees. This can be done by fine-tuning the employee value proposition with respect to pay and benefits, schedule flexibility, career growth opportunities and job satisfaction,” according to the report.

Mercer said employers in hot markets might adjust their compensation strategies to help them recruit talent from less constrained regions — an option that wasn’t available during the pandemic, when shortages were far-reaching.

“Healthcare organizations may need to pivot recruitment beyond typical boundaries to meet talent where it is,” the report notes. “Whereas some states and metropolitan areas will have significant labor shortages, others will have surpluses, and it will be critical to know where those surpluses are.”

Mercer predicts that employee pressure on compensation will continue if talent shortages intensify.

Healthcare workers have already campaigned for increased wages and benefits through union organization and strikes. In 2023, the industry witnessed its largest strike in decades when over 85,000 Kaiser Permanente workers walked off the job in order to achieve a 21% raise over four years.

Nearly one-third of nurses experiencing symptoms of burnout in 2023 said their electronic health records were a contributor, according to a report by healthcare IT research firm Klas.

Of those nurses, 40% said they were likely to leave their organization within the next two years. 

Many nurses don’t think they have a say in governance over the EHR at their organizations. Sixty-five percent of survey respondents didn’t agree that they have a voice in EHR changes, while 39% said they don’t feel they can ask for fixes.

One long-term frustration for clinicians is the amount of time and effort it takes to document care or perform other administrative work in EHRs, which can contribute to burnout.

Thirty-three percent of nurses reported symptoms of burnout in the Klas survey, which included feedback from roughly 75,000 respondents. 

For example, nurses argue they face technological challenges, like slow loading times or unplanned system downtime. Forty percent of nurses reported their EHR doesn’t have the expected response time, while nearly a quarter said the record isn’t reliable. 

Stress and burnout among nurses is a significant challenge for the healthcare workforce. Some research has found a large chunk of nurses are considering changing jobs or leaving the profession entirely due to burnout — a major problem for health systems who are still recovering from the workforce shortages and heightened labor costs they faced during the COVID-19 pandemic. 

Even though nurse satisfaction with their health records has increased, they still report insufficient training and system reliability problems that could contribute to burnout, according to the Klas report.

Training is also key to nurse satisfaction with their EHRs, but many nurses say their education was lacking —  nearly 40% reported their ongoing EHR education wasn’t sufficient, according to Klas. Forty-two percent of respondents reported their initial training wasn’t up to snuff, while 32% said it wasn’t specific to their workflow.

Improvements and upgrades aren’t always helpful to nurses either, according to the survey. Sixty-seven percent of respondents didn’t agree that upgrades improved the EHR. More than 70% said EHR optimizations weren’t delivered quickly enough, and 60% felt fixes weren’t timely. Half said changes to the EHR weren’t well communicated to them.

Artificial intelligence-backed notetaking assistants are likely reducing clinician burnout, but the tools’ financial impact for health systems is still unclear, according to an analysis by the Peterson Health Technology Institute. 

Early adopters of the scribes, which typically record providers’ conversations with patients and draft a clinical note, report they appear to lessen burnout and cognitive load associated with documentation. The tools could also improve patient experience by ensuring clinicians don’t have to focus on taking notes during an appointment.

But there’s still limited evidence on the scribes’ effect on productivity and financial performance, according to the PHTI report. Still, health systems said savings could arise as the technology and implementation process improve.

About 60 AI scribes are currently being rolled out in the healthcare sector, according to the PHTI analysis. The field is crowded, with tech giants like Microsoft and Oracle offering their own tools alongside startups including Abridge, Nabla and Suki. 

Adoption of the documentation tools has been uncharacteristically fast for the industry, which is often beset with long sales cycles and implementation plans, PHTI wrote in the report, which included interviews with health system leaders, technology companies and industry experts participating in its AI task force. 

The promise of the notetaking assistants is significant for health systems and clinicians. Providers have long struggled with a heavy workload of administrative tasks they say stretch into their personal time and impede patient care.

The “driving force” behind many health systems’ decisions to adopt AI documentation products is reducing clinician burnout — a major concern for organizations facing workforce shortages, according to the report. 

And the tools could be having an impact. In one example, Mass General Brigham, one participant in the AI task force, reported a 40% relative reduction in burnout during a six-week survey pilot. Providers at Washington-based MultiCare reported a 63% reduction in burnout and a 64% improvement in work-life balance.

“Ambient documentation has proven to be one of the most effective and impactful methods for enhancing the provider experience,” Adam Landman, chief information officer at Mass General Brigham, said in a statement.

Health system leaders said the scribes could improve care too, allowing physicians to focus their attention on the patient rather than a computer screen. One study by the Permanente Medical Group found that 81% of surveyed patients reported their physician spent less time looking at their computer when using an AI scribe. 

However, health systems aren’t seeing clear impact in financial metrics, like the number of patients that providers have time to see or the accuracy of billing codes. 

Currently, finances often aren’t the main reason for implementing a documentation tool, according to the report. Still, some health systems expect that clinics could eventually add more patients as they increase adoption of the AI scribes — but others argued increasing patient load could reverse the tools’ progress when it comes to burnout.

Among clinicians, actual uptake of the AI scribes varies. Use is typically divided into three groups: A cohort of clinicians who utilize them frequently, a group that uses the product for some visits and another cohort that rarely or never uses the documentation assistant, according to the analysis. 

Once a scribe is widely available, adoption rates are between 20% to 50%, according to the analysis. 

James Phillips was working as an emergency physician at Beth Israel Deaconess Medical Center in Boston in 2015 when a man walked into Brigham and Women’s Hospital across the street and shot and killed cardiovascular surgeon Michael Davidson.

Though Phillips was physically unharmed, the shooting served as a reminder of the several times he had been assaulted on the job.

There was one time when a patient spat blood, contaminated with hepatitis C, on him. And another when a patient threw an iPhone at his face.

“It started me on this pathway of looking back on my own early career and realizing that I’ve been the victim of violence several times,” recalled Phillips, now the chief of disaster medicine for the American College of Emergency Physicians, or ACEP, and chief of disaster and operational medicine at George Washington University.

Since the Boston shooting, attacks against healthcare workers have continued to rise.

Healthcare workers were five times more likely than those in other industries to be physically attacked while at work in 2018, according to the Bureau of Labor Statistics.

Some providers say the COVID-19 pandemic made violence worse.

In early 2023, the Massachusetts Health and Hospital Association issued a report and “call to action” on workplace violence at healthcare facilities in the state, based on an ongoing monthly survey of member hospitals. The organization saw an uptick in violence as the pandemic waned and hospital patient volume surged – a violent incident was reported every 38 minutes in 2022, up from every 57 minutes in 2020.

The American Hospital Association said healthcare workers experienced a “sharp increase” in violence after the pandemic, making it “more difficult for clinical staff to provide quality patient care.”

Phillips and ACEP now study violence against physicians. In ACEP’s annual membership poll this year, 91% of respondents said they or a colleague had been threatened or attacked in the previous year.

The data makes healthcare the “most violent non-law enforcement industry in America,” Phillips said.

Hospital groups, providers focus on guidelines

Healthcare workers are in a unique position because, particularly in emergency medicine, they have an obligation to treat people who might potentially put them in danger.

“I think it would be helpful to have some medical-legal guidelines that that allow us to know what our rights are once we’ve been attacked in the emergency department in terms of actions that can be taken against that person,” Phillips said. For example, would clinicians be held liable for abandoning the patient if they refuse to treat someone who is belligerent?

Seeking answers, physician and hospital organizations have created guidelines for preventing and managing violent interactions.

Other groups, like the MHA, have adopted codes of conduct for violence prevention.

MHA’s document calls for specialized training when appropriate — particularly for psychiatric and dementia patients — and post-incident debriefings by management, according to Patricia Noga, MHA’s vice president of clinical affairs.

“It was a template for, and guidelines for hospitals then to take and develop their own,” Noga explained.

In addition to the guidelines, hospitals should consider architectural redesigns, like rethinking the proximity of providers to room exits, and having at-risk staff wear duress alarms, Noga said.

Other strategies hospitals should consider include beefing up security, hardening entrances, providing escorts through the building or parking areas and adopting surveillance technology. However, there’s no good data on which strategies work better than others, she said.

A few states, notably California, have enacted policies requiring healthcare organizations to take concrete steps toward improving worker safety.

Provider groups have lobbied for federal legislation. One bill, introduced in April 2023, would have given healthcare workers the similar legal protections as commercial pilots and flight attendants. However, the legislation appears to have stalled after being referred to the House Judiciary Committee and again in the Senate Committee on the Judiciary.

Providers pivot to high-tech surveillance

Among the increasing violence, artificial intelligence companies have billed themselves as a new avenue for detecting violent actors.

One company called ZeroEyes, a Pennsylvania-based developer of “computer vision” software to detect brandished guns from images captured by security cameras, is seeing growth in the healthcare industry, according to Jonathan Norton, the firm’s vice president of commercial sales.

ZeroEyes taps into existing camera installations and, backed by an operations center staffed around the clock, determines if images flagged by the AI system are real threats. If appropriate, the company said it alerts clients and local police of potential danger in three to five seconds, then provides near-real-time updates on the potential assailant’s location and travel path.

Lane Dermatology, a four-physician group in Columbus, Georgia, signed on as a ZeroEyes customer this year. Though the independent practice has not experienced violence, founder Joshua Lane has been adjacent to it over the years, and said he would rather be prepared if it does ever happen.

Three people, including a nurse, were killed in 2008 at a hospital where Lane performs surgeries. In 2019, a gunman entered the clinic of a dermatology colleague of Lane’s in Gainesville, Georgia. Police shot and killed the suspect after a nurse was able to escape to a safe spot to call 911.

Lane, an Air Force flight surgeon with degrees in counterterrorism and homeland security who served in law enforcement for 15 years, presented at a national medical meeting this year on active shooters in healthcare settings.

Although his practice already had protocols for active shooters, he started looking into early-warning technology after the conference.

“Decrease the [response] time,” Lane advised. “The more that shooter is in your office, the more things can happen.”

In his lecture, Lane recommended keeping plans basic.

“The main thing is just to have a system and be aware of it. You don’t have to have an exact plan, but just know what to do if it happens,” he advised. “Have a panic button, have doors you can lock. Know your local sheriff and police department, talk to them.”

 

Fewer physicians are considering leaving the profession in 2025 than in 2024, according to a survey from the Harris Poll and electronic health record provider Athenahealth.

Part of physicians’ improved job satisfaction was driven by increased adoption of artificial intelligence, the researchers said. Fewer physicians reported the technology was over-hyped, and they saw the most promise in transcription services and capabilities.

Still, physicians shared concerns about the fate of the industry long-term and only 3 in 10 physicians were optimistic about the direction of U.S. healthcare generally. Respondents were most concerned about interoperability challenges, their organization’s financial health and meeting regulatory requirements.

Athenahealth, an electronic health record vendor that sells patient engagement tools and healthcare AI products, and the Harris Poll surveyed more than a thousand primary care and specialist physicians nationwide in January to understand physician attitudes about the state of their profession and the adoption of emergent technologies.

The team reported a decrease in physician burnout rates and intentions to quit in 2025 relative to 2024 — a welcome finding after multiple years of high physician turnover following the COVID-19 pandemic.

In a blog post accompanying the survey, the team said technology improvements, especially the use of AI to address administrative burdens, was a “main driver” of physicians’ changing sentiments.

“For years EHRs were cited as one of the major contributors to physician burnout, so it stands to reason that as the technology improves, we’ll hopefully start to see sentiments improve as well,” the team said in the blog.

While previous independent research has linked frustrations with EHRs to turnover, those studies have cautioned against attributing discontent to a single factor. Researchers note burnout is complex and can stem from frustrations with pay, difficult patients, volume and intensity of work, and advancement opportunities.

In Athenahealth’s survey, 3 in 10 physicians said AI has the potential to reduce burnout. The same number reported they are currently using AI in their practice, while the majority have yet to adopt the technology. 2025 was the first time researchers queried physicians about their AI use, so a spokesperson couldn’t comment on whether AI adoption had ramped up among physicians.

The survey did find an increase in “resources and tools” available to physicians in 2025 relative to 2023. Physicians also reported spending more time with patients relative to 2023, which could partially explain the shift in burnout and quit intentions, according to the survey.

Fifty-one percent of physicians report having adequate time with patients, up from 43% in 2023. While 35% of respondents said patient volumes and costs negatively impact their ability to provide quality care at least once a week, that’s down from the 50% of respondents who said volumes and costs impacted care at least once a week in 2023.

Still, physicians report more optimism about potential use cases of AI. They said the greatest possible benefits to using AI in healthcare will be improved clinical documentation and transcription services, identifying patterns in patient data and reduced administrative burdens. 

However, there is a gender gap forming between male and female physicians in how comfortable they feel using the technology to treat patients. 

While 66% of male physicians would use AI for diagnosis support and 54% would use the technology for treatment planning, only 46% of female physicians would leverage the technology for diagnostics and just 36% would use it for treatment planning.

Across genders, physicians said their top concerns with using AI include the loss of a human touch in healthcare, an overreliance on the tools to diagnose patients and improper diagnoses.

Each day, healthcare workers are threatened with violence in the United States.

Violent injuries are five times more prevalent in healthcare than in other industries, and 75% of the approximately 25,000 workplace assaults reported annually occur in the health industry, according to the Occupational Safety and Health Administration.

A survey released in February by National Nurses United found that 8 in 10 nurses experienced at least one incident of workplace violence in the past year.

The amount of workplace violence in healthcare prompted Shan Sinha to found wearable safety company Canopy. The company offers a personal duress button that hospital workers can clip to their badge or clothing to alert system security. The button also works in home health settings as part of an expansion launched this year — Canopy says it covers more than 200,000 healthcare workers.

Healthcare Dive caught up with Sinha, the CEO and founder of Canopy, to talk about workplace violence, technology and how health systems can create an environment that fosters safety.

HEALTHCARE DIVE: Why do you think healthcare workers are more likely to experience violence compared to employees in other industries?

SHAN SINHA: When [healthcare workers] get assaulted or attacked by patients, [the incidents] tend to go underreported. Sadly, staff tend to conclude that it is just part of the job.

Hospitals are raw, emotional places. Your loved ones are needing care. The system is under stress. Staffing ratios are way lower than they used to be.

When we looked at all the data coming out of the pandemic, clearly there was a rise in violence and assault against staff, but it hasn't receded over the last few years. And it affects retention; it affects burnout. It's one of those things that obviously is going to show up if you're trying to take care of patients on a day-to-day basis.

Imagine having to take care of that patient at 11 p.m. at the end of a long, dark corridor. That can be a pretty anxiety-inducing circumstance when you don't know what could happen.

How does the Canopy button work? Is pressing it easier than just using a phone to contact help?

When a healthcare worker encounters incidents, they have the potential to escalate very quickly. Seconds matter. If you're in a situation like that, you've entered into a mode where your brain isn't even able to think, and so the ability to instantly press a button and know that it works like the way it might if you called 911 is hugely critical.

The button just clips onto the back of your ID badge. It's super lightweight. What's nice is whenever you show up at work, it belongs to you, so you carry it with you everywhere you go. You know that button is going to be with you when you need it.

When you press that button, it works with a network of devices that we plug in all around the hospital. The system can pinpoint the identity of the individual and where they are in that hospital, whether they're in the parking lot, or on the fourth floor of building Y. That information is then transmitted and delivered instantly within milliseconds to central security, who can dispatch an officer. It is transmitted to nearby coworkers who can get a note that says this patient needs help in room 403. If you happen to be going into somebody's home, you can connect to law enforcement and send 911, and then coordinate that with your hospital's security team.

How can healthcare organizations create a culture of safety going forward?

It's obvious you're going to invest in protecting your caregivers against pathogens — gloves, masks, scrubs, all those sorts of things — but safety against this form of violence at work, I think there's an opportunity to really think about that as a top priority.

The way you create a culture of safety is by prioritizing the investment in keeping your staff safe, and I think that will result in both qualitative and quantitative benefits in fewer nurses to retrain. We know that training a nurse costs at least $50,000 per individual. These are high-skilled workers, and holding on to those assets, investing in them, supporting them will obviously result in significant benefits, not only to the health system but to patients themselves.