Dr Mark Friedberg: Clinician Burnout and Reorganization of the Practice

Practice reorganization can worsen clinician burnout, explained Mark Friedberg, MD, MPP, senior natural scientist and director of the Boston office at RAND Corporation, who also discussed his solutions for addressing burnout in the practice.

Clinician burnout has been an issue in the US for years; how does the shift to alternative payment models exacerbate an already serious issue?
It’s not completely that the payment models are the source of the problems that we saw in the study. But it certainly could be the case in other research we’ve done so not the health affairs paper in particularly but we did a report back in 2015 which was RAND did with the American Medical Association, we found that alternative payment models for practices that really make a big investment in them, it’s a major reorganization of the practice. They have to do a fair amount of work on their information technology systems. Sometimes they have to, to get the capital to invest in those things, change their organizational model.

So, you’ll see a lot of small practices start to join up with larger systems, maybe sell themselves to hospitals, for example, to get access to capital. And those kinds of change are really stressful to staff. You know, it really is a change in how people have been doing things. If you’ve been doing one thing for decades and all of a sudden because of a change in payment away from fee-for-service you have to reorganize the practice. Change is hard, and I think we see some of that.

What solutions out there are more likely to work or do a better job to address clinician burnout?
I think the most promising solutions to professional satisfaction and burnout problems are gonna be taken by managers who treat it on an individual organization basis. So let’s say you’re running a large provider group and you find out that your physicians are becoming more burned out over time. I think it’s important then to do a deep dive in finding out the reasons for that.

If it turns out that the reasons are that they’re being asked to see too many patients or that your electronic health record (EHR) is configured in a way that it makes it extremely hard for them to do their job. Treat the underlying cause, change that EHR, change the configuration, go with a different vendor, or switch your scheduling system so that everybody’s happy again, patients and the providers. Nobody likes being rushed. Both patients and providers are gonna agree on this.

Then if you’re able to identify and try to improve those underlying causes go back to the physicians who were the most burned out and say hey did this work? And if it did then great you did the very best thing that you possibly could. I think that’s far better than like mindfulness training. For example, my analogy I always make is two canaries in a coal mine. If you have physicians who are being burned out, that’s like your canary, there’s probably something you should worry about in that mine or in that practice. The mindfulness training is a little bit like toughening up the canary which is not the best way of handling the situation.
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