What Graduating Fellows Need to Know About Physician Burnout and EHRs in 2016 – Part I
December 19, 2016 | Sumit Som, MBBS
Sarah L. Timmapuri, MD, FACC, is the chief quality informatics officer and a practicing cardiologist at Hackensack University Medical Center in Hackensack, New Jersey. She graduated medical school from the Northwestern University Feinberg School of Medicine in Chicago, followed by residency and cardiology fellowship at UMDNJ-New Jersey Medical School and Hackensack University Medical Center. She is passionate about contemporary causes of physician burnout in the U.S., and has given talks on the implication of physician burnout on the quality healthcare delivery, especially as it relates to the use of the electronic health records (EHR) in daily practice.
I recently spoke with Dr. Timmapuri about the influence the ongoing health care reform has on cardiologists in the community, and what graduating FITs and early career cardiologists might expect when they start a practice. This will be a two-part interview series with Dr. Timmapuri. Part I will focus on physician burnout in general and the Part II will specifically focus on the effect of EHRs on physician burnout. Dr. Timmapuri can be reached at Sarah.Timmapuri@hackensackmeridian.org.
Physician burnout is recognized as a widespread problem among doctors. It seems to affect the entire spectrum of the physicians’ professional life from medical students to near retirees, across all specialties. What do you feel is the number one cause of burnout among early career physicians and young cardiologists?
There are so many causes. I think that a major cause of burnout in all fields of medicine is an inability to be true to ourselves. That may sound soft and fuzzy, but, at its heart, it is very practical. I think we, as physicians, value caring for our patients the most. However, we have been forced to spend so much of our time documenting our care that this documentation takes away from the actual care. We trained for years to think about our patients – to think about what could be ailing them, figure out how to narrow the possibilities, use deductive reasoning and investigative testing and interviewing, and then to help them with advice and treatment when necessary. When thinkers are forced to become “documenters”, is it any wonder that we are facing record numbers of burnout? I haven’t yet met a physician or nurse who has told me that they went into medicine because their life’s dream was to sit in front of a computer. And yet, study after study tells us this is what our current system is asking them do.
The issue of physician burnout among practicing doctors is inextricably tied to contemporary health care regulation. Many doctors feel the progressive lack of autonomy associated with health care reform has contributed heavily towards the prevalence of burnout. What is your opinion on this?
Physicians have been squeezed by regulations and requirements over and over – E&M documentation requirements, clinical quality measure reporting, metrics upon metrics and new acronyms every year describing new programs designed to assess their quality. Physicians think about health care as care; however, the system has forced them to have to think about metrics and documentation. Because of this, some physicians feel they have lost their autonomy – outside forces tell them what they have to do in every visit. In the past, at every visit, there was the physician and the patient. Now, there is the physician, the patient, and what is required. Many physicians also feel that as soon as they learn and understand the current regulations, they are changed. It is a never-ending game in which the rules are ever-changing. This lack of control is a strong contributing factor to burnout.
Although western medicine has lost most of its gender biases, yet only one fifth of cardiology fellows are currently women. Do you have any special message for the FIT female cardiologists to prevent professional burnout?
So many professional women, particularly those in highly demanding, male-dominated fields, like cardiology, face tremendous pressure to succeed – to be everywhere at the same time. I have met so many highly successful, brilliant, young female cardiologists who describe a feeling of “failing” everywhere, because simultaneous success is so difficult to achieve. They often express that in order to succeed professionally, they have to skimp at home, or the reverse. They sometimes describe feeling that they have to rotate their energy and focus from one priority, home/children, to another, career/patients and then to another, spouse/extended family. I think my message to young female cardiologists would be to take a deep breath and define “success” carefully. For example, a busy cardiologist early in a new practice may not be able to make home-made cakes and decorations for a child’s birthday, attend every single after-school activity in person, be a fellowship director and maintain a pristinely clean and perfectly neat home. However, a busy cardiologist could hire help with cleaning and cooking and laundry and spend non-working hours doing after-school activities with store-bought goodies with an emphasis on spending quality, focused time with loved ones. For high-achievers like female cardiologists, it may be a little difficult to “outsource” tasks, but is well-worth it in the end.
In an article in recent article in the Journal of the American College of Cardiology about burnout during cardiology fellowship, the author notes that 38 percent of cardiologists experience burnout. What is your formula for a successful work-life balance as it pertains to ambulatory practice?
My father, who was also a cardiologist in private practice and was my mentor until he died, always told me, “no one on their deathbed ever said, ‘I wish I spent more time in the office.’ You can spend 24-hours a day in the office working on your charts (paper at that time, of course). Go home. The charts will still be there in the morning.”
Nowadays, some physicians have contests regarding who has more charts left to complete on the weekend. They have developed their own methods for getting themselves to complete them. It is not unusual for someone to text or post, “As long as I close another 20 encounters, I get to go to the movies with my kids today!” Physicians have started a “second shift” at home. They get the visits done in the office, take care of phone calls, go home, spend time with family/spouses, and then at night get on the EHR and finish notes and close encounters. Is early physician burnout really a surprise? How can anyone sustain that kind of schedule?
As a first step to combat burnout, I suggest engaging your patients in the medical record by documenting with them during the visit. Place the orders in front of them – they will understand our frustrations better and they will understand how much work goes into caring for them in this new electronic world. Get the bulk of the note and the orders done while in the room with the patient. Try to get the encounters closed before you leave for the day. Once they pile up, they become a monkey on your back that haunts your every move and can feel like an insurmountable task.
Second, take a moment to assess what is important in life to you and make time for that by outsourcing the rest. By doing that, we can be true to ourselves. An authentic life is a happy, balanced life.
This article was authored by Sumit Som, MBBS, a Fellow in Training (FIT) at Rutgers New Jersey Medical School based at Hackensack University Medical Center, Hackensack, New Jersey.