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 His tiny plot, located in the shadow of the 537-bed teaching
hospital, helps Halloran cope with burnout from long hours and the
stress of surgery on gravely ill patients.
"You really have to find the balance to put it a little more in
perspective," he said.
Hospitals such as St. Joseph Mercy Ann Arbor have been investing in
programs ranging from yoga classes to personal coaches designed to
help doctors become more resilient. But national burnout rates keep
rising, with up to 54 percent of doctors affected.
Some leading healthcare executives now say the way medicine is
practiced in the United States is to blame, fueled in part by
growing clerical demands that have doctors spending two hours on the
computer for every one hour they spend seeing patients.
What's more, burnout is not just bad for doctors; it's bad for
patients and bad for business, according to interviews with more
than 20 healthcare executives, doctors and burnout experts.
"This really isn't just about exercise and getting enough sleep and
having a life outside the hospital," said Dr. Tait Shanafelt, a
former Mayo Clinic researcher who became Stanford Medicine's first
chief physician wellness officer in September.
"It has at least as much or more to do with the environment in which
these folks are practicing," he said.
Shanafelt and other researchers have shown that burnout erodes job
performance, increases medical errors and leads doctors to leave a
profession they once loved.
For a graphic, click http://tmsnrt.rs/2zMlmuy
Hospitals can ill afford these added expenses in an era of tight
margins, costly nursing shortages and uncertainty over the fate of
the Affordable Care Act, which has put capital projects and payment
reform efforts on hold.
"Burnout decreases productivity and increases errors. It's a big
deal," said Cleveland Clinic Chief Executive Dr. Toby Cosgrove, one
of 10 U.S. healthcare CEOs who earlier this year declared physician
burnout a public health crisis.
WHAT TO DO?
Hospitals are just beginning to recognize the toll of burnout on
their operations.
Experts estimate, for example, that it can cost more than a $1
million to recruit and train a replacement for a doctor who leaves
because of burnout.
But no broad calculation of burnout costs exists, Shanafelt said.
Stanford, Harvard Business School, Mayo and the American Medical
Association are working on that. They have put together a
comprehensive estimate of the costs of burnout at the organizational
and societal level, which has been submitted to a journal for
review.
In July, the National Academy of Medicine (NAM) called on
researchers to identify interventions that ease burnout. Meanwhile,
some hospitals and health insurers are already trying to lighten the
load.
Cleveland Clinic last year increased the number of nurse
practitioners and other highly trained providers by 25 percent to
1,600 to handle more routine tasks for its 3,600 physicians. It
hired eight pharmacists to help with prescription refills.
Atrius Health, Massachusetts' largest independent physicians group,
is diverting unnecessary email traffic away from doctors to other
staffers and simplifying medical records, aiming to cut 1.5 million
mouse "clicks" per year.
Insurer UnitedHealth Group, which operates physician practices for
more than 20,000 doctors through its Optum subsidiary, launched a
program to help doctors quickly determine whether drugs are covered
by a patient's insurance plan during the patient visit. It is also
running a pilot program for Medicare plans in eight states to shrink
the number of procedures that require prior authorization.
Similarly, Aetna Inc this year began a behavioral health program
that eliminates prior authorization requirements for admission to
some high-performing hospitals.
DOCTOR OVERLOAD
Experts define burnout as a syndrome marked by emotional exhaustion,
cynicism and decreased effectiveness. Many burned out doctors cut
back their hours to cope, and a disturbing number commit suicide.
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A landmark 2015 Mayo Clinic study found that more than 7 percent of
nearly 7,000 doctors had considered suicide within the prior 12
months, compared with 4 percent of other workers. About 400 a year
go through with it.
Driving the burnout symptoms is the burden of data entry on clumsy
electronic medical records systems that doctors must use to prove
the quality of their care, said Dr. Christine Sinsky, vice president
of professional satisfaction at the American Medical Association.
Sinsky recently conducted an experiment in her own internal medicine
practice in Dubuque, Iowa. She asked a staff member how many mouse
clicks it takes to order and record a single patient's flu shot in
their electronic medical record. The answer: 32.
She has visited some practices where a doctor had to record flu
shots for more than 1,000 patients because only the doctor was
allowed to enter the order.
Such mandates reflect an overly strict interpretation of federal
health reforms designed to encourage doctors to use electronic
medical records, such as the 2009 Health Information Technology for
Economic and Clinical Health Act that required doctors to
demonstrate "meaningful use" of the systems.
"We have to recognize the exacting toll that the first generation of
electronic health records have had on physicians," Sinsky said. "I
would identify it as one of the most important drivers of physician
burnout."
Pre-approval requirements from health insurers for many services and
quality metrics built into Obamacare have added to doctors'
administrative duties.
"We've got this measurement mania. We've got to back off of that,"
said Dr. Paul Harkaway, chief accountable care officer for
Michigan's St. Joseph Mercy Health System, a part of Trinity Health,
a national not-for-profit Catholic healthcare system.
As a result of these requirements, primary care physicians spend
more than half of their 11.4 hour workday performing data entry and
other tasks, according to a September AMA/University of Wisconsin
study published in the Annals of Family Medicine.
To manage, doctors often finish work at home in the evening, a part
of the day known as "pajama time."
COSTS TO THE HEALTHCARE SYSTEM
Doctors' suffering can take a direct toll on patients. In a 2010
study, Shanafelt and colleagues found that the more burned out a
surgeon was, the more likely he or she was to report a major medical
error. Other studies have shown that burnout drives up rates of
unnecessary testing, referrals to specialists and hospital
admissions.
When doctors quit, it costs an estimated $800,000 to $1.3 million in
recruitment, training and productivity costs, depending on the
specialty.
Even when physicians don't leave, they can contribute thousands of
dollars in costs each year "just as a matter of inefficient
functioning," said Dr. Colin West of the Mayo Clinic.
The trend has medical malpractice experts concerned. CRICO, the
malpractice carrier for Harvard University's two dozen affiliated
hospitals, recently had to settle a handful of cases because doctors
were too burned out to fight, even though CRICO believed it could
win.
"The clinician just wanted it to go away," said Dr. Luke Sato,
CRICO's chief medical officer. Sato estimates that an average breast
or colorectal cancer malpractice case might cost $750,000 to $1
million to settle.
The crisis has Harkaway worried for his colleagues in Michigan, and
for his profession.
"Working with doctors every day, you see it," he said. "They are
just beat down."
(Reporting by Julie Steenhuysen; Editing by Michele Gershberg and
Editing by Edward Tobin)
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