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Causes of The Epidemic of Physician Burnout

Thursday, January 5th, 2017

Causes of The Epidemic of Physician Burnout
Thursday, January 5th, 2017
https://www.stepsforward.org/modules/physician-burnout

At the Jan. 3, 2017 Minnesota Academy of Medicine meeting, Dr. Mark Linzer gave an informative presentation on the work of his team at HCMC to mitigate physician burnout.

It is estimated that significant physician burnout now affects half of US physicians, and it is getting worse. Dr. Linzer cited a recent Mayo study: http://newsnetwork.mayoclinic.org/discussion/physicians-and-burnout-its-getting-worse/

Despite a nationwide shortage of physicians, burnout is both a symptom and cause of the critical problem facing organizations wanting to retain and recruit physician employees as “providers” in health care organizations. There are narrowing employment options for doctors outside of such large clinic systems because independent medical practices continue to be bought up at a record pace by hospital-clinic organizations http://www.forbes.com/sites/scottgottlieb/2013/03/15/hospitals-are-going-on-a-doctor-buying-binge-and-it-is-likely-to-end-badly/#296758694f72

Mark offered a “demand-control model” for physician burnout in which generic physician stress (pressures on doctors) is counter-balanced by the doctors’ ability to have control of their work environments and the quality of supports which are in place to reduce stress. The model’s reference: http://ajph.aphapublications.org/doi/abs/10.2105/AJPH.71.7.694

From surveying the doctors at HCMC, two identified reasons for increasing burnout stand out:

1. Time pressure during patient encounters. Not enough quality clinical time with patients, nor the flexibility to adjust their efforts to the patient’s needs.

2. Inputting electronic health records (EHR) now dominates physicians’ outpatient and many inpatient clinical encounters and distract from doing quality patient care.

Dr. Linzer’s recommendations included:
Bringing scribes into the examining room whenever possible. The doctor is then free too interact with the patient while the scribe silently types away (in the background).
Expand the (allowable) 20 minute doctor care visit to 30 minutes.
Add (support) perks like a doctor’s lounge, quiet room, child care services and a 7 hours on, 7 off schedule, rather than one of 12 on 12 off. More time off.
Formal listening sessions sponsored by the organization to hear the gripes and complaints of the doctors.

When asked during the Q and A about the financial drivers of physician burnout?, Dr. Linzer said his he’s convinced his recommendations (in progress) save money for the organization — essentially by improving physician productivity and job satisfaction.

A number of audience members commented on the negative consequences to physicians when they are viewed by their organizations as “providers” (health care workers) rather than physicians (professionals). He agreed that this is a real problem.

Not examined or discussed during this fine talk was the elephant in the examining room, a connection between HCMC’s financial incentives and the mounting stresses experienced by its employed doctors. Many people, including policymakers, are not aware that HCMC as our public safety net hospital-clinic organization is now an Accountable Care Organization (ACO) called Hennepin Health http://content.healthaffairs.org/content/33/11/1975.abstract So as with other ACO’s, the organization’s financial incentives must be to reward physicians for spending less money on patient care. How does this square with “increasing physician productivity”?

Also, as a psychiatrist by training, I am very concerned about patients’ medical care data privacy and confidentiality. If an EHR is mandatory in the HCMC system, how can patients be assured of privacy and confidentiality in mental health and substance use interviews and encounters? And, if scribes are seen as the answer to reducing documentation stress for most doctors, what is the effect of having another person in the examining room room during one’s doctor-patient visits?

Consumer-directed Health Care Reform will happen in 2017 only if we contact our State Legislators, Congresspeople, and Senators

Saturday, December 3rd, 2016

MPPA wants MN state health care funding policy changes to be based on expanded consumer (patient and family) direction and control, real consumer choices of doctor and other “providers,” competitive markets for care and insurance in Minnesota involving price transparency, and support for the Rep. Tom Price national Obamacare repeal and replace efforts. The Minnesota legislature convenes January 3. What do you think?

Given the coming changes in the federal ACA law, will BCBSM, Medica, HPI and other MN nonprofit insurance players develop and market consumer-directed health care insurance products to lower health care costs?

The MN Medicaid HMO industry relies on “competitive bidding” among Minnesota’s health care insurance oligopoly companies to win contracts which affect hundreds of thousands of people. They claim they are losing money. However, the public is in the dark about the deals — the criteria, accountability, and actual dollars considered by the state bureaucracy in rewarding these contracts. We know only of the results of proclamations and decisions made by the MN Department of Commerce (Mike Rothman) in its naming of health plan winners and losers, enrollment caps and the like.

We are aware that Minnesota’s nonprofit health plan companies are both insurance companies and employers of health care “providers.” How does this potential conflict of interests square with developing and expanding consumer-directed market-based health care and insurance products?

The people of Minnesota are angry and restless about the costs and access to health care insurance, the instability and costs of taxpayer-funded Medicaid HMOs for the poor and ACA-eligible middle class citizens, and the current uncertainty and cost for many thousands of rural Minnesotans dependent on the individual insurance market now facing escalating premiums, greatly diminished coverage options, and narrow “provider” networks.

See:

http://www.startribune.com/minnesota-should-tackle-health-care-costs-now/404361916/

http://www.startribune.com/medica-s-exit-from-state-s-public-health-programs-raises-tough-questions/404359536/