1. Why Do We Care Mukta Panda MD MACP
Connecting Passion With Purpose In The Clinical And Learning Environments
Why Do We Care
Mukta Panda MD MACP

2. WHAT ARE WE REALLY TALKING ABOUT?4 4

3. 9

4. Controlled Interventions to Reduce Burnout in Physicians
February 2017
Controlled Interventions to Reduce Burnout in Physicians
A Systematic Review and Meta-analysis
Maria Panagioti, PhD1; Efharis Panagopoulou, PhD2; Peter Bower, PhD1; et al George Lewith, MD3; Evangelos Kontopantelis, PhD1,4; Carolyn Chew-Graham, MD5; Shoba Dawson, PhD6; Harm van Marwijk, MD6; Keith Geraghty, PhD7; Aneez Esmail, MD6
Author Affiliations
JAMA Intern Med. 2017;177(2): doi: /
“This finding provides support for the view that burnout is a problem of the whole health care organization, rather than
individuals”
J Gen Intern Med Jan; 29(1): 18–20.
Published online 2013 Sep 4. doi: /s
PMCID: 10 Bold Steps to Prevent Burnout in General Internal Medicine
Mark Linzer, MD, Rachel Levine, MD, MPH, David Meltzer, MD, PhD, Sara Poplau, BA, Carole Ward
Medscape Family Medicine
Physician Burnout: It Just Keeps Getting Worse
Carol Peckham
Disclosures January 26, 2015

5. Burnout RATES NATIONALLY: Residents 50-75%, Physicians 55%
Linzer et al. Am J Med
2001;111:
Turnover costs related to Burn out: average
$250,000/departing physician
Buchbinder et al. Am J Manag Care 1999;5:1431-8
Of 17,000 Physicians surveyed, 48% cutting back, retiring early, trying to find ways to limit patient care secondary to burnout
2016 American Physicians Foundation Survey
Relative to physician burn out health care organizations have:
reduced patient access to care,
reduced patient satisfaction,
reduced patient medication adherence
Linn et al. Med Care 1985; 23: ; DiMatteo. Health
Psychol 1993;12:
93-102
Female physicians are 2.3 X’s more likely to commit suicide than women in the general public
400 physicians per year
Example of impact: Typical Panel size=2300
1 million patients per year lose their physician to suicide 11

6. “Burnout- Heading In the Wrong Direction”
Shanafelt et al, 2015
Mayo Clinic Proceedings
Highest rates in front- line specialties: Family Medicine, General IM and Emergency Medicine 12

7. HOW DID WE GET HERE? TOP 10: Electronic Medical Record13
Electronic Medical Record
Workplace demands
Culture of Medicine has changed
Inefficient chaotic work environments
Limited or no control over workload or schedule
Less resources available to complete the work
Less ability to shape career to focus on interests
Work load is commonly part of the home environment
Insufficient time to document adequately
Medical decision-making completed more by outside guidelines of which we may not agree
Misalignment of our values

8. EHR / EMR: Time Sinks 14

9. WHY CARE? 15
WHY ARE SMART ACADEMIC CENTERS, HEALTH SYSTEMS AND MEDICAL ORGANIZATIONS LOOKING AT THIS VERY CAREFULLY?
Medical Organizations
(i.e. ACP, Amer Coll of Surgeons, AMA AAMC, SGIM)
Academic Health Care Centers, (ie Mayo, Cleveland Clinic, NYU, Univ of Mass Gen, VCU)
Large Health Care Organizations (ie Kaiser, Accensia, Banner)

10. Organizational Climate, Stress and Error in
Primary care: The Memo Study
Advances in Patient Safety 16
30% more likely to leave job in 2 years 
PATIENT CARE outcomes linked to organizational work
conditions- such as burn out!
When we assess with the tools –such as Mini Z, we can
predict:
Every 1 point increase in burnout on Mini Z = 30-40% increase in likelihood a physician will be reducing their work effort in next 24 months

11. IMPACT ON HEALTH CARE: $$$$17
1. Less committed and less productive physicians
Statistics show us poor quality of care with higher burn out scores
Less desire for patient and team engagement
$$$$
Value Based Pay
$$$
Loss of staff and poor patient outcomes $$$

12. Impact on Health Care: 18
Statistics show an increased rate of patient safety errors with higher burn out scores
Lower patient satisfaction scores with higher physician burn out scores
Decreased
professional effort
At risk: Reputation, medical malpractice costs, health system or practice reporting to regulatory agencies
$$$
Loss of patients
$$$$$$
$$$$$

13. Key Initiatives/Targets
Health System's and Organization's
Key Initiatives/Targets 19
Clinical Performance
Re-admissions, and Length of Stay
Patient safety errors,
Recruitment and Retention
Access to Care

14. The quality indicator now available on all web sites!
Don’t avoid the burned-out physician, 20
Avoid the organization/practice who burned them out
PHYSICIAN BURN OUT SCORES:
The quality indicator now available on all web sites! 20

15. Solutions need to be organizationally driven21
Organizational analysis
Weill Cornell- Physicians averaged 15.1 hr/week processing quality metrics-
785.2 hours per physician per year
(Med Rec, Documenting for the right code, No copy paste, yet note from day before is 2/3 the same, no clinical benefit in the work they are doing, documentation stuck in the fee for service era)
Organizational think tank Solutions
Team based documentation and order proposals
Decrease data entry for highest paid professionals as much as possible
Clinical Informatics and Pharmacy techs on each team

16. Solutions need to be organizationally driven22
Organization analysis:
Mayo Clinic- “Solutions are not the responsibility of an individual physician”.
Designed a 9 step approach for organizations to promote physician Well-Being
Sample solutions
Promoting less than full time work- to improve recruitment and retention
Use of daily huddles Use of Scribes Decreased fatigue
Increased use of allied health professionals on the teams
Focused on efficient work environment and