Article

Administrative burden among the factors driving physician burnout

By Caroline Watson | June 14, 2021

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Physician burnout levels were already high pre-pandemic, but COVID-19 has added a new set of stressors. To understand the factors impacting the overall physician experience and how to address the causes of burnout, athenahealth fielded the Physician Sentiment Index between Oct. 13, 2020 and Dec. 23, 2020 to physicians using a variety of EHR vendors. Based on survey data from 799 physician respondents, a few key themes emerged.

Most importantly, burnout is felt quite frequently among physicians, with 28 percent reporting feeling burned out at least once per week.

Administrative work is a burden

It comes as no surprise that administrative work is a major pain point for many physicians surveyed. “What ends up happening at a lot of practices is that you work 40 hours a week seeing patients, and you tack on a ton of extra hours on your own just to get all that administrative work done,” said Deb Reid, FNP and owner, Instinctive Wellness. “It is a big chunk, and it is really frustrating.”

Unfortunately, physicians reported spending an average of 13.5 hours per week on tasks other than direct patient care. Physicians who report spending a lot of their time documenting and performing tasks outside of direct patient care end up feeling the most crunched for time — and, of course, less satisfied in their work. These correlations are particularly concerning because only 29 percent of physicians surveyed agreed or strongly agreed that their practice is set up to minimize their administrative burden, making it one of the lowest-scoring items on the survey.

Surprisingly, just 39 percent of physicians reported that their organization has taken any concrete steps in the last 12 months to mitigate physician burnout. There’s no one-size-fits-all solution, but giving physicians more control over their time is a place to start. Wanting more control over her time so she could take better care of her patients was a motivator for Reid to open her own practice. Alleviating the administrative burden may also disproportionately benefit the groups who are struggling the most, like women physicians.

Women suffer from burnout more frequently

Gender predicted nearly every aspect of physician experience, even after adjusting for age, race/ethnicity, organization type, and specialty. Women are experiencing burnout more frequently than men, with 51 percent of women reporting feeling burned out a few times a month or more, compared to 43 percent of men. Women are also less likely to feel their workload is manageable and less likely to believe they would still be at their organization in the next three years.

One possible explanation for the gender gap is time distribution, or at least perceptions of it. The women surveyed reported spending more time on administrative tasks than men, amounting to 29 percent of their total self-reported working time, compared with 25 percent for men. This finding is especially striking next to a recent study using athenahealth’s EHR data that found women spend more time in patient visits than men. “Feeling connected with patients is a way many physicians find meaning in their work. If women feel they’re spending more time on admin work and less with patients, this should raise some concerns,” said Bethany Sheridan, Ph.D., Senior Manager, Research and Insights at athenahealth.

Perhaps most telling, the biggest difference in time distribution came in time working at home outside of normal work hours. Women report spending 19 percent of their work time at home after-hours, compared to just 14 percent for men. Taking steps to alleviate the administrative burden may help.

Jennifer Morrison, APRN, MPH, and pediatric nurse practitioner at the Angel Harvey Family Health Center, says it’s also important to recognize the impact the COVID-19 pandemic had on working mothers. “Because of COVID, we had childcare issues all of a sudden,” Morrison explained. “We’re trying to do telehealth visits, but I’ve got kids running in the background, and we’re also trying to get them set up on remote school.” Study after study have shown that working mothers shouldered the increased childcare responsibilities throughout the pandemic, and these feelings of general burnout are difficult to separate from the workplace.

Older physicians are more satisfied with their work

Interestingly, older respondents felt more positively about many aspects of their jobs than younger respondents did, particularly with respect to workload and burnout, organizational support, and care quality. Physicians aged 65 and older reported feeling burned out because of their job less frequently — 35 percent are burned out a few times a month or more, compared to 48 percent of younger physicians. They were also more likely to feel they have enough time to spend with each patient and feel their workload is manageable.

Life-stage factors may play a role. The data show that respondents in this older age group are working fewer hours per week, and older physicians largely predicted they won’t still be at their current organization for at least three years, hinting that some are nearing retirement. Older physicians are generally more senior in their organizational hierarchies, and they may also take on leadership roles. Feeling like they have more control over how they spend their time may help explain why older physicians are more satisfied with their work.

Physician experiences vary by organization type

Across the board, physicians at Federally Qualified Health Centers (FQHCs) appear to be struggling more than their counterparts at independent practices. More physicians at FQHCs are burned out (55 percent) than physicians at independent practices (44 percent). They’re also more likely to feel rushed with patients (89 percent) than physicians at independent practices (63 percent).

Morrison says that working at a community health center is tremendously rewarding and fulfilling, but it also comes with challenges that contribute to feelings of burnout. Patients at FQHCs typically experience complex medical, social, and behavioral needs, and it can be difficult for providers to access the additional community resources necessary to help address those needs. “When you know that your patient with asthma is also having trouble keeping their electricity on, that can be a weight on your shoulders,” said Morrison. “Caring for our patients often requires additional resources, and we don’t always have them.”

There’s also a heavy administrative burden. FQHCs are subject to many reporting requirements, from Uniform Data System (UDS) clinical quality measures to HRSA audits and more. “All of those entities create complex charting requirements and workflows that take the provider away from that valuable one-on-one time with the patient,” said Morrison. “In my head, I always have these checklists of what I have and haven’t clicked. All of that can really contribute to extra stress and burden for providers and staff at FQHCs.”

Morrison emphasized that the factors contributing to burnout at FQHCs are systemic, and the solutions will need to address those systemic issues. “The current reimbursement structure puts pressure on FQHCs to create provider encounters, and then providers are feeling pressure to maintain productivity,” she explained. “There’s a need for payment reform, for sure.”

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