Engaging Clinicians Across the Southern Tier

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Physician burnout has interwoven consequences on the affected physicians, their patients, the health care organizations they work for, and the community as a whole. Burnout can lead to poor quality of patient care, decreased patient satisfaction, safety issues, and health care access issues.

According to the Mayo Clinic survey in 2014, 54% of doctors say they are burned out. Another survey done in 2015 indicated that 88% of doctors are moderately to severely stressed. Burnout can lead to poor quality of patient care, decreased patient satisfaction, safety issues, and healthcare access issues.

It’s also affecting the number of practicing physicians in the workforce. According to Jackson Healthcare, 59% of doctors wouldn’t recommend a career in medicine to their children. “Physicians are cutting back on the amount of work that they do, in addition to retiring earlier or transitioning to other careers,” states Wayne C. Teris, MD, FAAFP, Chief Medical Officer for Care Compass Network.

Burnout also affects physicians’ lives in a number of other ways including putting a strain on their personal and professional relationships, increased substance use, and physicians having their own medical problems. Physician suicide rate is the highest of any profession, which is more than twice that of the general population.

Physician burnout is more than just being tired. Signs include emotional exhaustion (nothing more to give), depersonalization (compassion fatigue), and inefficacy, or a sense of low personal accomplishment. The Maslach Burnout Inventory is a survey that objectively measures these signs, looking for at least one of these markers. “The prevalence of burnout is remarkably high,” remarks Dr. Teris. Physician burnout is increasing, in 2011 forty-five percent of physicians were reporting burnout and just three years later that number increased to 54%. “This is not just physicians,” Dr. Teris says. “The same is true of nurses, social workers, mental health providers, and all those who care for people in our community.”

Care Compass Network (CCN) arranged for the Maslach Burnout Inventory survey to be administered to physicians, Nurse Practitioners, and Physician Assistants throughout our 9-county region in 2018. CCN had over 250 respondents to the survey and in comparison to national scores, our 9-county region scored higher than national averages in emotional exhaustion, but lower in depersonalization. Overall, our providers felt positive when it came to personal accomplishment markers. “For the area, we have to work on the workplace and things we can do to make our providers’ lives easier in terms of exhaustion,” remarks Dr. Teris. “If you look at comments from physicians, a few things bubble to the top all the time: administrative tasks, EMR [Electronic Medical Record] and the amount of time it takes, and a feeling of lack of respect and control; that external agencies and administrators are controlling the way the physician practices.”

Care Compass Network’s Board of Directors and leadership has identified Primary Care Physician engagement as a high priority and crucial to the success of our Performing Provider System (PPS). “In order for us to be successful in improving care for Medicaid members and other members of the community, we have to have engagement of Primary Care Physicians,” says Dr. Teris.

With this in mind, the CCN Primary Care Advisory Council (PCAC) was created last spring. Comprised of twelve primary care providers from across the Southern Tier, the council meets monthly to discuss issues that are important to patients, providers, and the communities they serve. “In the end we feel this will improve care in our community,” says Dr. Teris. Those on the council are feeling heard and attempting to bring back change to their organizations. They are also forming important collaborative relationships with our Community-based Organizations (CBOs) in order to more effectively manage Social Determinants of Health (SDoH). “I think they are really listening and appreciating some of the objective things they can do to try and make their life better and try and improve their institution,” shares Dr. Teris.

Inadequate numbers of trained support staff are a major contributor to increased administrative tasks for the physicians. Two barriers to adequate staffing are funding as well as having adequately trained workforce. This has been an issue in our 9-county region and CCN is working to partner with local educational institutions to improve the workforce in our communities. Important to that improvement is determining what positions need to be bolstered to improve healthcare overall and understanding how best to train and retain staff.

Dr. Teris mentions a case of burnout in a physician from a small, rural town in the area. He was in his 60’s and ready to retire due to burnout, a result of not having adequate staffing in his office and inadequate administrative time. The health system that his practice was in recognized his value to the community. Because of that they made an investment in his practice to add staff, allow staff to work at top of license, as well as allowing for increased administrative time. This transformed his practice and he not only continued to work, but began enjoying his work again. “The productivity in his office went up. Even through there was an initial investment, those that were there, including himself were more productive just based on the fact that they had the help they needed and it made their lives easier,” says Dr. Teris.

In an effort to bring awareness to the rising concern in physician burnout and suicide rates, CCN holds community-wide events on physician burnout, bringing in nationally recognized speakers. The first, Dr. Dike Drummond, a Mayo trained family doctor, executive coach, and CEO of the thehappymd.com delivered his “Burnout Proof” workshop in June 2018 to over 100 participants. Dr. Paul DeChant, who has over 25 years of clinical and management experience in medical group leadership, as well as expertise in Lean Management and preventing physician burnout followed in November of the same year.

Educational events, like these, will continue this June with a visit from Dr. Rishi Manchanda, a leader at the forefront of a new generation of healthcare practitioners. Dr. Manchanda will be speaking in Ithaca and in Binghamton, specifically discussing upstream management of social determinants and their effects on health and health care provider burnout.

As New York State, and especially the Southern Tier drives towards the transformation of Healthcare, our mission is to support and strengthen the budding relationships between healthcare systems, primary care providers, mental health providers, and community organizations as value-based payment models develop and mature. The creation of the council and community events on burnout helps ensure that their voices are heard during this transformative period in healthcare.