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How Massachusetts Can Help Fix The Doctor Burnout Crisis

(Jafar Ahmed/Unsplash)
(Jafar Ahmed/Unsplash)

Recently, the American Medical Association, the Mayo Clinic and Stanford University School of Medicine published welcome news for our nation’s health care community. According to a new study, our country’s physician burnout rate decreased from 54.4 percent in 2014 to 43.9 percent in 2017. This marks the lowest level of burnout among U.S. physicians since 2011.

We are gaining solid ground. But we still face an uphill climb to curb the far-reaching effects of this public health epidemic. Burnout increases the chances that doctors face depression, attempt suicide or leave their practice. The patients of burned-out doctors don't do as well as those who have healthy doctors. In one study, burned-out doctors made as many medical errors as those in teams with a safety grade of C or D.

It’s only fitting that Massachusetts, a state known for health care innovation, take a lead in solving this nationwide issue. The new legislative session on Beacon Hill gives us that opportunity.

Much of our clinician burnout problem stems from the exorbitant amount of time doctors spend on administrative tasks in the electronic medical record or billing — about two hours of administrative work for every hour of seeing patients. This pulls us away from our main job of caring for people. Our state Legislature can help alleviate this burden weighing down physicians by reducing documentation requirements. In areas where state and federal law differ, such as on information exchange and privacy about genetics, STDs and substance use conditions, Massachusetts should align its laws with those of the federal government. That way, physicians can meet requirements at both levels in less time.

In one study, burned-out doctors made as many medical errors as those in teams with a safety grade of C or D.

Furthermore, clinicians often spend hours outside the typical workday writing medical notes meant only to satisfy state and insurance requirements. Information that is irrelevant to a patient’s care and health outcomes makes a clinical note bloated and difficult to read. Fewer requirements benefit patients on two fronts. They free up more face-to-face time with physicians, and they result in clearer and more concise medical notes. This improves communication between providers and leads to better-coordinated care.

Collaborative, team-based care is another essential element in reducing clinician burnout. Our nurse and advanced practice clinician colleagues are vital parts of our health care system. But legislative mandates keep them from practicing everything they've learned through years of education and training. For example, in Massachusetts, nurse practitioners cannot prescribe medication to patients without physician supervision. Requiring doctors to review the expertise of our trusted colleagues’ recommendations is time-consuming, costly and pointless.

According to the American Association of Nurse Practitioners, 22 states currently allow nurse practitioners the full scope of practice at the top of their license, including prescribing. Right now, Massachusetts is among those states with the most restrictive practice regulations. House and Senate legislation awaiting passage on Beacon Hill would lift these restrictions, thus freeing up time for doctors to spend time with patients.

[Administrative work] pulls us away from our main job of caring for people.

While it is paramount that Massachusetts residents receive the best possible care, public and private payers each have their own set of quality metrics for patient outcomes. This not only puts extra documentation pressure on physicians — it also increases administrative costs. It isn't realistic to think that physicians can improve upwards of 30 different metrics at one time. Instead, the state can alleviate this pressure by mandating that insurance payers finally decide on one set of meaningful quality metrics, so that it is clear where doctors and organizations need to focus. That way, all of our patients’ needs can be properly met, no matter which company’s name is on their insurance card.

The Association of American Medical Colleges predicts a shortage of up to 120,000 physicians looming over the United States by 2030. Although we’re just beginning to see years of hard work and increased awareness coming to fruition in declining burnout rates, we can’t afford to exacerbate these problems by forcing our clinicians out of practice. It’s difficult enough to access care in Massachusetts. Why make matters worse by wasting physicians’ time with exhausting clerical work? By enacting legislation that lets doctors be doctors, Massachusetts can once again take center stage in leading our country toward a better health care system.

Related:

Karim Awad Twitter Cognoscenti contributor
Dr. Karim Awad is the medical director of clinician wellness at Atrius Health, the largest nonprofit, independent physicians group in Massachusetts.

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