To address burnout’s underlying causes, look to team-based care
Christine Sinsky, MD, AMA vice president of Professional Satisfaction
James Jerzak, MD, a family physician at Bellin Health in Green Bay, Wisconsin, is only in his 50s but until recently spent more time looking forward to retirement than to another day in practice. His days were overstuffed with clerical work and administrative tasks and undernourished by the rewards of delivering direct patient care.
But in redoing their model of care toward one that is team-based, Bellin Health has helped change Dr. Jerzak’s view of his life in medicine.
“Team support has made practicing medicine fun again—and much more fulfilling,” he says.
Editor's note: This story helps kick off a new topic hub that centralizes the AMA’s essential tools, resources and content to help you in Reinventing Medical Practice.
The new model consists of a core team of two medical assistants (MAs) or licensed practical nurses and one half nurse per physician, along with an extended care team of case managers, diabetic educators, clinical pharmacists and RN care coordinators. The medical assistants serve as scribes to help relieve the burden of electronic health-record documentation, entering pending orders, referrals and more. The same teams work together every day to maintain stability.
Christine Sinsky, MD, a general internist and AMA vice president of Professional Satisfaction, recently shared Dr. Jerzak’s story to emphasize the importance of team-based care in combating burnout.
The battle against burnout is especially critical because of new research that quantifies the potential impact of professional dissatisfaction on the physician workforce and patients’ access to care. The study, published today in Mayo Clinic Proceedings, found that one in five physicians intends to reduce clinical work hours in the next year. Meanwhile, roughly one in 50 physicians intends to leave medicine for a different career in the next two years.
The nationwide survey of 7,000 physicians from all specialties found that, of those wanting to cut back on work hours, 28.6 percent said their primary reason for doing so was to spend more time with family. Another 26.2 percent listed frustration with Medicare and insurance issues or frustration with the work environment as the primary reason for reducing their time at work.
If just 30 percent of physicians follow through on their intention to leave medicine in the next two years, the study estimates that nearly 4,800 physicians would leave the workforce—a loss roughly equivalent to eliminating the graduating classes of 19 U.S. medical schools in each of the next two years.
“An energized, engaged, and resilient physician workforce is essential to achieving national health goals. Yet burnout is more common among physicians than other U.S. workers, and that gap is increasing as mounting obstacles to patients care contribute to emotional fatigue, depersonalization and loss of enthusiasm among physicians,” AMA President David O. Barbe, MD, MHA, said in a statement. “The AMA is urging Congress, hospitals and health plans to recognize the coming crisis as an early warning sign of health system dysfunction. America’s physicians are the canary in the coal mine.”
The environment, not the individual
Dr. Sinsky estimates that about 80 percent of burnout is driven by systems factors and only 20 percent is related to individual factors, so there needs to be an inside and outside strategy to address the problem.
“If over half of you as physicians are exhibiting some sign of burnout, we have to recognize that the problem is rooted in the external environment rather than reflecting weakness in a few susceptible individuals,” she told the crowd during her keynote speech at the American Conference on Physician Health in San Francisco. Hosted by the Stanford University School of Medicine in collaboration with the AMA and the Mayo Clinic, the event aimed to bring together physicians, researchers and others from across the country to find ways to restore joy to the practice of medicine.
In the United States, more than $100 billion a year is spent on researching new tests and treatments, Dr. Sinsky noted. While that innovative research is vital, she voiced concern that only a fraction of that amount is spent on researching optimal delivery models to deploy those tests and treatments. The AMA continues to work to improve this.
“For the last three years, one of the strategic focus areas—one of only three focus areas at the AMA—has been to improve professional satisfaction and practice sustainability,” she said.
The AMA’s work in this area covers four domains:
- Practice science research.
- Convening and collaboration.
- Regulatory influence and interpretation.
- Assessment and activation.
Each domain allows the AMA to work toward bringing health care organizations and physicians together through a team-based approach for burnout improvement.
A new STEPS Forward™ module outlines nine steps to create the structures that can result in more satisfied and productive physicians and other health professionals. The module also includes a way for health care organizations to track the business case for well-being by estimating their own cost of physician burnout and return on investment for interventions to tackle the problem.
Case studies are also available to show how executive-leadership teams at a variety of organizations are starting to address joy in medicine. A recently published JAMA Internal Medicine article, co-written by Dr. Sinsky, further outlines “the business case for investing in physician well-being.”
Physicians and their organizations can also join the AMA at Lambeau Field in Green Bay, April 18–19, to learn how Bellin Health designed and implemented a team-based care plan that is being recognized nationally as a game-winning plan.
“What if joy in medicine were a standard heath system measure both at the institutional and federal levels?” Dr. Sinsky asked. “Imagine a day when organizations compete for physician resources in part on their ability to support joy in medicine.”
This is the kind of practice environment Dr. Sinsky would like to see for her niece, who recently started in practice as a general internist, and for others like her.
“It is our collective work going forward to contribute to a world where [my niece] and other people just entering our wonderful profession can go to work and no longer feel that working in clinic is unbearable,” she said. Health professionals, Dr. Sinsky added, will provide better care when they “go to work every day feeling trusted and empowered, feeling like I am reconnected with a meaning and a mission of the work that I do.”
The AMA’s STEPS Forward collection offers free online modules that help physicians and system leaders learn their risk factors for burnout and adopt medical practice solutions to reignite professional fulfillment and resilience, including modules that focus on how to change key workflows and processes, such as pre-visit planning and synchronized prescription renewal. Several come thanks to a grant from, and in collaboration with, the Transforming Clinical Practices Initiative. The AMA also offers other online CME to improve physician well-being.