When I was 21, I drove an ambulance in New Orleans. The city had the highest rate of gun violence in the country at the time, which kept me busy. But I spent way too many hours picking up non-emergency patients who treated my ambulance as a taxi ride to the ER. It got to the point where my fellow drivers and I called our vehicles the “cab-u-lance.” Each day I recorded in a notebook the runs in which my transport mattered. I was happy, of course, to do my part to help whoever needed it, but to stay engaged and feel fulfilled I needed to know that I had helped save a life or made a difference.
Doctors feel this need to matter acutely and profoundly. It’s their raison d’être, why they endure the day-to-day stress of medical practice. And yet the typical doctor’s day is filled with paperwork, box checking, and hurried patient encounters that don’t merit or challenge their expertise. Is it any surprise that burnout — half of doctors suffer from it — is an epidemic?
I’ve been thinking a lot about physician burnout recently. It factors into nearly every conversation I have these days with clients and health care leaders who view it as an existential threat to their missions and bottom lines.
As the CEO of a health care technology company — far from a doctor myself but surrounded by a team of incredible ones — I feel an acute sense of urgency around this issue. My driving purpose for the past two decades has been removing extraneous work from doctors. I co-founded athenahealth on the business idea of wicking away scut work from physicians and their offices to help doctors focus on their patient.
We’ve made great strides in moving offices from paper to electronic records. But in the process this has all too often added to the distance between doctors and their patients. I believe the health technology industry can, and must, do better.
Over the past year, I set my research team loose on aggregated data of the day-to-day clinical and financial activities logged by more than 111,000 doctors and their organizations who are using athenahealth’s cloud-based platform in order to investigate what causes — and cures — physician burnout and what can be done at the organization level to put patient care back at the center of physicians’ jobs. What we’ve landed on is a compelling metric we call “capability.” Derived from the canon of management literature, capability is a measure of how much workers feel they have the support they need to effectively serve their customers and feel fulfilled doing so. In a variety of service industries, scholars have found that what best predicts employee motivation is not necessarily compensation, paid time off, or other standard human resources interventions — it’s whether employees feel they can meet their customers’ needs. Whether you’re a fast-food worker or neurologist, it turns out that what matters most is doing right by your customer or patient.
We’ve found that this concept from outside of health care applies, with some modifications, to physicians. In a survey my team conducted of doctors who use athenahealth’s network, physicians who felt they were supported to provide excellent patient care were 17 percent more productive, 76 percent less likely to plan to leave their groups, and 61 percent less likely to show signs of burnout. This suggests that, as an industry, we must go beyond piecemeal interventions that treat symptoms instead of causes, or are designed to help doctors adjust to a status quo that is clearly unsustainable. Instead, we must radically redesign doctors’ jobs to restore the primacy of the physician-patient relationship.
What does it mean, in practice, for doctors to “feel supported”? In our survey, the most resilient and engaged doctors reported that they had the latitude to provide high-quality care to their patients along with the tools and resources to support and enable that latitude. In fact, variation in perceptions around these three dimensions of physician support — latitude, tools, and resources — appears to describe much of what separates a burned-out doctor from one who feels engaged and happy to show up at the office every day.
Let’s start with latitude. Doctors are highly trained experts who too often feel like clerical workers. They need assurance that the quality of the care they deliver will continue to be their domain, and not simply be dictated to them by government programs and payer contracts. And they need to know that their role in assessing and capturing the patient story will never be replaced by checkboxes on an electronic health record. Too often we see that provider organizations, in their rush to consolidate acquired practices, impose a “command and control” strategy — issuing organization-wide guidelines before communicating with those most affected by them — which limits autonomy and unwittingly compromises productivity and well-being in the process. I’m not suggesting that doctors should rely purely on their judgment, or that health care leaders should give up on efforts to reduce needless variation and excess waste — only that preserving latitude, where appropriate, is an essential part of the equation.
Here’s an example. At Privia Health, a national practice management company, doctors are held to shared performance targets but are given local control over how to meet those targets. “As a group,” says Dr. Jim Sams, CEO of Privia Medical Group – Georgia, “we come together around the science of medicine and best practices. But the art of medicine is the individual autonomy we support at the local practice level. How you hit the target for hemoglobin A1c in Atlanta may be different than in Savannah.”
For doctors to perform at their highest level, they must also be given the resources needed to be totally present with their patients. This includes ongoing training and support in adopting new technologies and systems. Even in an era of seemingly ceaseless reporting and administrative requirements, it is possible to design workflows and non-clinical teams that relieve physicians from the crushing busywork that distracts them from the patient. In our survey, physicians who agreed that their organization values teamwork were half as likely to exhibit signs of burnout.
Finally, we must focus on developing technology-enabled tools that enhance the doctor-patient relationship rather than diminish it. A fundamental truth about medicine in 2018 is that providers need to see the whole picture of a patient to succeed in their care. And yet, lack of interoperability and data-sharing among systems and sites of care prevents this from occurring.
To support providers in the moments of care, we need to infuse their workdays and workflows with the same kind of consumer-grade user experiences they enjoy in the rest of their lives. This means liberating them from electronic health records that require 4,000 clicks while easing their documentation burden with smart voice assistance and machine learning. Likewise, we should leverage artificial intelligence not only for medical moonshots like curing cancer but to remove extraneous work and surface the right information for the patient in front of them
Health care is in crisis and doctors, the frontlines of this industry, are caught in the middle. It’s time to move from merely talking about physician burnout to making the kinds of tangible, data-backed changes that will transform the physician experience. When we support doctors, we free them up to experience the joy of medicine once again. And we will all be better for it.
Jonathan Bush is CEO and president of athenahealth, a health care technology company based in Watertown, Mass., and author of the New York Times bestseller “Where Does it Hurt? An Entrepreneur’s Guide to Fixing Health Care” (Portfolio, 2014).