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PROFESSIONAL WELLNESS


PRACTICAL STRATEGIES FOR MANAGING STRESS AND PREVENTING PHYSICIAN BURNOUT

NORCAL Group is committed to safeguarding, guiding, and protecting our physicians and healthcare professionals. This extends to supporting the health and well-being of all healthcare team members, because we know that when they’re at their best, they can deliver the best care to their patients. 

Professional Wellness Channel
Free On-Demand Webcasts:
Available to All Clinicians

Playlist

Click the playlist icon in the top corner of the video below to see full playlist

Playlist Includes: Clinician Suicide Responsive Measures  Responding to Unanticipated Outcomes in Patient Care  Proactive Problem Solving: The A3 Method  Value Stream Map: How to Add Value to Your Process (Click the 'Playlist' icon in the top corner of the video above to view all)

CME credit is available to NORCAL’s policyholders for some of these presentations via MyACCOUNT and the MyNORCAL mobile CME app, along with dozens of other risk management and patient safety activities. Typically each activity is an hour and provides an opportunity for AMA PRA Category 1 Credit™.

Article Series One
Reducing the Stress of Managing Electronic Health Records (EHR)

Solutions to Reduce EHR Burdens and Decrease Physician Burnout

Series One: Electronic Health Records

Electronic health records (EHR) — including electronic medical records (EMR), electronic prescribing, electronic patient portals, and computerized physician order entry (CPOE) — are a main cause of physician burnout. Research has identified key aspects of EHR systems that contribute to physician burnout.

Full Article »

Focus on Positive Developments in EHR

Series One: Electronic Health Records

EHR developers are aware of the problems with EHR usability and interoperability that contribute to physician burnout, and they appear to be increasingly focused on clinician-focused optimization. Government agencies have developed programs and initiatives to improve EHR usability and interoperability. Various organizations have contributed to a body of research linking EHR usability and interoperability issues to patient safety. Healthcare organizations are joining forces to prompt the development of interoperable EHR software and devices. These developments suggest there is positive movement toward EHR systems that provide more benefits and fewer burdens to the clinicians who use them.

Full Article »

EHR Enhanced Communication During Clinical Encounters

Series One: Electronic Health Records

Patient engagement can be a key to reducing physician burnout, but EHR burdens can negatively affect patient-clinician interactions. Patient-centered EHR use is a well-researched field. Lee et al. developed a mnemonic to remind clinicians of patient-centered EHR strategies: HUMAN LEVEL.

Full Article »

Developing EHR Expertise to Increase Satisfaction and Productivity

Series One: Electronic Health Records

An EHR system is a complicated tool that requires sufficient training and practice to gain competency. Achieving EHR proficiency can reduce frustration, increase efficiency and mitigate the effects that EHR burdens have on physician burnout. Research indicates that physicians with adequate initial training are significantly more satisfied with their EHR system and that satisfaction remains consistent for more than five years following initial training.

Full Article »

Reducing Physician Data Collection Tasks

Series One: Electronic Health Records

Physician burnout is caused by multiple factors, one of which is clinicians’ increasing responsibility for data collection. The EHR system alone is not entirely at fault.

Full Article »

Using Scribes to Decrease Clerical Burden

Series One: Electronic Health Records

Scribes — individuals trained to enter data into the EHR in real time with physician review — can decrease physician burnout caused by EHR-associated clerical burden.

Full Article »

Organize for EHR Change

Series One: Electronic Health Records

EHR systems are works in progress. Legislators need the wisdom and creativity of physicians to change them into ideal tools for supporting patient care. Organizing for EHR change can be both strategic and therapeutic. Physicians can also reduce burnout by building community around the EHR issue. There are various ways to advocate for increased clinical relevance and usability in EHR systems, which, in turn, can reduce physician burnout.

Full Article »

Working With IT Staff to Improve EHR Usability

Series One: Electronic Health Records

IT departments can help improve EHR usability and reduce physician burnout through better health IT design. EHR developers and designers are expected to provide a better EHR in the future, but while the next generation EHR is in development, the IT staff at your practice (or your vendor or a consultant, if you do not have IT staff) may be able to improve the usability of your existing system.

Full Article »

Talking to Administrators and Physician Leaders About EHR Optimization

Series One: Electronic Health Records

There’s a business case to be made for addressing physician burnout caused by EHR systems. At the most basic level, physicians with symptoms of burnout are twice as likely to leave an organization as those without such symptoms.

Full Article »

Making EHR Systems More Usable and Clinically Relevant

Series One: Electronic Health Records

Patient care documentation and order-entry are key contributors to physician burnout. EHR systems may satisfy billing and reimbursement requirements, but generally fail at supporting clinicians in healthcare delivery. The burdens that EHRs introduce are compounded by the lack of certain functionality in existing systems.

Full Article »
 

Research indicates that a majority of physicians may be suffering from burnout and that burnout is nearly twice as prevalent among physicians as among other workers in the United States. Who or what is responsible for physician burnout is a complicated question that has prompted a great deal of research over many years. Burnout in physicians has been defined as emotional exhaustion, impersonal reaction to patients, feelings of incompetence, low achievement, and lack of motivation. There are multiple tools to measure physician burnout and wellness. Assessing the problem is a key organizational and personal strategy for ensuring quality patient care and physician well-being.

Despite burnout being a work-related condition, burnout solutions, until fairly recently, have focused on physician self-help. But self-help does not solve the root causes of burnout, which can be attributed to systems and administrative requirements. Consequently, there is a business case to be made for burnout reduction and physician wellness.

Burnout can affect every aspect of healthcare delivery. For example, burned-out physicians are more likely to be involved in poor outcomes and have lower patient satisfaction scores, which can have a significant effect on government reimbursement, patient retention and reputation.  Burnout can negatively affect workplace culture by diminishing empathy among coworkers, causing disengagement from teamwork and reducing commitment to corporate values. In addition to the costs associated with burnout-related loss of goodwill, decreased reimbursement and patient injury, burnout is associated with high physician turnover costs— it can cost from $500,000 to more than $1 million to replace a physician and onboard a new one. In other words, it costs two to three times a physician’s annual salary to replace that physician. (Turnover costs for nurses experiencing burnout are comparable.) Like many issues associated with healthcare, prevention is cheaper and safer than managing the downstream consequences of full-blown burnout.

NORCAL Group's Risk Management Department has identified three broad categories of work-life stressors that can impact the wellness of healthcare professionals. Resources have been created to help physicians, physician leaders and administrators understand and address these sources of stress, with the goal of reducing professional burnout. There’s a real difference, though. Rather than rehashing the causes and effects of these stressors, our intent is to offer information, practical resources and innovative strategies to help healthcare professionals create meaningful change and improvement. Let’s get started.

BUSINESS/ADMINISTRATIVE STRESSORS

Electronic Health Records

Electronic health records (EHR) — including electronic medical records (EMR), electronic prescribing, electronic patient portals, and computerized physician order entry (CPOE) — are a main cause of physician burnout. There are strategies for reducing EHR-associated burnout, including: improving EHR usability, using scribes, delegating data collection duties and improving EHR expertise.

Reimbursement

Fragmented and variable reimbursement models, increasing price competition, contracting insurance networks and increasing documentation requirements can all exacerbate physician burnout. Several groups are organizing to demand reductions in paperwork associated with reimbursement, and the Centers for Medicare and Medicaid Services (CMS) has indicated it is working on reducing physician regulatory burdens. Until that time, there are strategies that physicians can use to mitigate the stress associated with reimbursement and managing EHR burdens. More information coming soon

Loss of Autonomy

Physicians report that loss of independence and autonomy contribute to burnout. In fact, a recent NYU School of Medicine study of physician burnout found that physicians working in small, independent primary care practices had dramatically lower levels of burnout than the national average. This study suggests that physicians and administrators can work together to reduce the stress associated with loss of autonomy by returning certain aspects of patient control back to physicians — such as patient scheduling, appointment length, case mix and work hour scheduling. More information coming soon

Production Pressure

Production pressure is a significant cause of physician burnout. Relieving production pressure requires interventions on both organizational and individual levels.  More realistic workload planning, adequate staffing and optimum delegation, paired with more efficient time and patient management can reduce production pressure. More information coming soon

Meeting CME, Licensure and Certification Requirements

Physicians are under increasing pressure to complete continuing medical education (CME) and maintain certification, and it’s often at significant financial cost and commitment of their limited time. The stress associated with meeting education, licensure and certification requirements can contribute to physician burnout. Physicians can decrease their burden by optimizing the process for obtaining CME credits and contributing to certification reform efforts. More information coming soon

PATIENT-CARE STRESSORS

Unhealthy Aspects of the Culture of Medicine

The culture of medicine may set physicians up for burnout and prevent those who are struggling from seeking help. An important aspect of preventing burnout and achieving wellness is to question the value of pursuing unrealistic ideals at the expense of well-being. Fear of stigma, lack of confidentiality, and licensing repercussions are common reasons physicians fail to obtain necessary mental health treatment. Administrators and physician leaders can play a major role in eliminating the stigma and fear of reprisal associated with seeking help. More information coming soon

Challenging Patients

Physicians who have high numbers of difficult patient encounters are more likely to suffer from burnout. A number of variables can be at work during a challenging patient encounter. But what might seem like an insurmountable problem may be fairly manageable with some minor adjustments. Resolving difficulties in the early stages of a challenging patient relationship can be the best solution for all parties involved. More information coming soon

Lack of Support from Physician Leadership

Ineffective physician leadership can contribute to stress and burnout. Physician leaders can reduce the risk of physician burnout by modeling and supporting a collaborative culture and improving leadership skills through training methodologies. More information coming soon

Limitation on Care Decisions Due to Reimbursement Issues

Physicians regularly encounter patients who cannot afford optimal or even necessary medical care. There are various unappealing ways to deal with the problem, including lowering the standard of care, discharging or turning away patients, and bending billing and reimbursement rules. These approaches raise obvious patient safety, liability risk and ethical problems. There is no perfect solution to this complex issue, but there are methods for satisfactorily balancing the risks and benefits associated with treating indigent and underinsured patients. More information coming soon

PERSONAL STRESSORS

Unrealistic Physician Expectations

Unrealistic personal expectations can set the stage for and perpetuate physician burnout. They also contribute to work-life imbalance. Physicians can use multiple approaches to determine what matters most and start prioritizing in a way that both promotes patient safety and maintains physician wellness. More information coming soon

Responding to Unanticipated Patient Outcomes

Physician distress associated with being involved in an unanticipated patient outcome (also known as “second victim syndrome”) can last for months or even years. Second victim syndrome can exacerbate or trigger physician burnout. Physicians and administrators can use various strategies to avoid and manage second victim syndrome. More information coming soon

Litigation Stress, Administrative Action and Medical Board Investigation Stress

Being sued or investigated by the medical board can exacerbate or trigger burnout. Physicians who are sued and/or investigated may already be suffering from second victim syndrome, which can make matters worse. Physicians need to recognize their vulnerability to the stress that accompanies litigation and administrative actions and actively seek the support they need. Administrators should also be sensitive to exacerbating burnout, second victim syndrome and litigation stress symptoms when limiting privileges prompted by an unanticipated outcome. More information coming soon

Work-Life Imbalance

Achieving work-life balance can be particularly challenging for physicians, who often devote far more than 40 hours per week to work-related activities. Physicians, with the support of administrators, can maintain balance between work and non-work activities by using deliberate planning and setting realistic expectations. More information coming soon