The declining trajectory of efficiency within the United States healthcare industry over the last several decades has had a profound effect on the quality of care, but patients are not the only victims of this antiquated system. National levels of physician burnout have been growing at an alarming rate, with as many as 42 percent of physicians reporting that they feel burnt out. Physicians experiencing burnout generally deliver lower quality care, and are more likely to reduce their hours or stop practicing altogether. This is especially concerning as it pertains to primary care physicians, as they tend to experience the highest rates of burnout among doctors. The work of a primary care physician consists of many crucial tasks, including screenings, vaccinations, counseling, behavioral health, family planning, and the prevention and treatment of chronic disease. This is before taking into account all of the additional time that physicians spend each day completing administrative work, and all of that writing, clicking, typing and checking boxes tends to add up.
According to a recent study conducted in 2017, as much as half of every primary care physician’s day is solely devoted to completing desk work between visits, which consists of responding to messages from patients and clinical staff, reviewing laboratory results, documenting patient visits within electronic health records (EHRs) and renewing prescription medications. Factoring in the additional stress of working the front lines during a global pandemic, the burden of these bureaucratic tasks becomes even more daunting. Physician burnout is clearly not an individual phenomenon, and it should not be addressed as such. A systematic predicament of this scale requires a methodical solution that confronts the root of the problem rather than retroactively managing the resulting symptoms. By integrating data driven patient relationship management applications into the current healthcare system, machine learning algorithms can help relieve some of the administrative burden that has fallen upon the shoulders of our indispensable physicians while simultaneously promoting increased levels of engagement among patients.
Before addressing this prevalent issue, it’s important to understand exactly what physician burnout is. According to a 2018 study published in the National Institute of Health’s Journal of Open Medicine, burnout can be defined as “a prolonged response to chronic emotional and interpersonal stressors in the work environment”. A number of external factors can affect the onset of physician burnout, such as workload, workplace environment, and relational stress resulting from constant interactions with patients, colleagues and clinicians. The symptoms of burnout can range from emotional and physical exhaustion to loss of motivation, interpersonal disengagement, and a decreased sense of accomplishment and satisfaction. In a survey conducted by the American Medical Association in 2017, the majority of responding physicians cited the burden of bureaucratic tasks as the primary factor contributing to burnout. Other major causes of physician burnout included excessive hours on the clock and a lack of uniformity within computerized practices.
When our physicians become overwhelmed to the point of burning out, it inevitably affects the quality of patient care and the success of patient outcomes. Cross-sectional studies have identified a correlation between physician burnout and substandard patient care practices, as well as an increased risk of 17 percent for being cited in a medical malpractice lawsuit. Further research is necessary before definitive conclusions can be drawn regarding these associations. Other studies have linked higher levels of emotional exhaustion in ICU physicians with increased rates of patient mortality in addition to lower perceived quality of interpersonal communication. This problem presents larger scale consequences as well, as the United States Department of Health and Services predicts that there will be a nationwide shortage of approximately 90,000 physicians five years from now, many of whom will have departed from medicine due to the effects of burnout. This anomaly is placing additional stress upon a national healthcare system that already struggles with a lack of medical professionals.
While there is no single solution that can address every aspect of physician burnout, patient relationship management platforms powered by artificial intelligence can certainly help solve the element of administrative burden. Electronic health records were originally intended to help physicians by digitizing patient charts and medical information, but instead of facilitating patient care, they have contributed to the problem of physician burnout. The aggregate of time that physicians spend interacting with EHRs at work amounts to over $365 million per day, which is roughly equivalent to what the United States spends on primary and secondary public education. Functions related to clinical ordering, charting, billing and quality improvement have all been compiled into EHRs, and clinics and hospitals have been forced to hire thousands upon thousands of medical scribes to help by shadowing clinicians and manually recording their orders and notes into the EHR. The very innovation that was meant to automate bureaucratic tasks in the healthcare industry has actually led to a net increase in faculty and staffing relating costs for providers.
Machine learning algorithms can improve upon this medieval solution by making the clinical system smarter and more efficient. AI has the potential to streamline the collection of patient data and eliminate the need for redundant documentation requirements, saving time for physicians and patients. Base-level artificial intelligence has already been implemented within EHRs to help with coding, billing and regulatory compliances, but there are many aspects of patient care that could benefit immensely from similar applications. Patient engagement platforms will also emphasize the role of the patient, allowing them to enter their own information, family history and medications remotely. The involvement of the patient in conjunction with the AI automation of data transfer processes would effectively reduce demand on healthcare professionals and their support teams, allowing physicians to allocate more time to the delivery of quality patient care.
The recent surge in physician burnout is yet another failure of the current healthcare model in the United States, and everyone from doctors to patients to clinics and healthcare providers are paying the price. Especially now in the wake of a global pandemic, physicians are our front line of defense, and we can’t expect them to do it all alone. It would be unfair to force the head chef at a restaurant to take phone reservations and process payments at the register in addition to running the kitchen, and it’s unfair to burden physicians with bureaucratic tasks that don’t affect patient outcomes. No one can replace or emulate the compassionate and conscientious care that primary care physicians are trained to deliver, but the administrative aspect of healthcare must be automated, simplified, and made accessible from a patient perspective. Short-term solutions must be implemented to preserve the sanity and wellbeing of our physicians today, but large-scale systematic reform is essential to ensuring that the physicians of tomorrow feel as though they are not facing these challenges alone.
- Amezcua, Jacob. 2020 Burnout Statistics And How AI Brings Hope For The Future. 3M Health Information Systems. February 2020. https://www.3mhisinsideangle.com/blog-post/2020-burnout-statistics-and-how-ai-brings-hope-for-the-future/
- Sukyung Chung, Ellis C. Dillon, Dominick L. Frosch, Amy E Meehan, Robert Nordgren. The Relationship Between Primary Care Physician Burnout And Patient-Reported Care Experiences: A Cross-Sectional Study. Quantitative Sciences Unit, Department of Medicine, Stanford University. March 2020. https://link.springer.com/content/pdf/10.1007/s11606-020-05770-w.pdf
- Tai-Seale M, Olson CW, Li J, Chan AS, Morikawa C, Durbin M, et al. Electronic Health Record Logs Indicate That Physicians Split Time Evenly Between Seeing Patients And Desktop Medicine. Health Aff (Millwood). 2017;36(4):655–62. https://pubmed.ncbi.nlm.nih.gov/28373331/
- Cipresso Pietro, Pizzioli Daniele, Riva Giuseppe, Wiederhold K. Brenda, Wiederhold Mark. Intervention for Physician Burnout: A Systematic Review. July 2018. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6034099/
- Could A.I. Turn The Tables On The Physician Burnout Epidemic? January 2019. https://medicalfuturist.com/physician-burnout/
- Peckham, Carol. Medscape National Physician Burnout & Depression Report 2018. January 2018. https://www.medscape.com/slideshow/2018-lifestyle-burnout-depression-6009235
- Dyrbye N. L., Shanafelt D. T, West P. Colin. Physician Burnout: Contributors, Consequences And Solutions. March 2018. https://onlinelibrary.wiley.com/doi/full/10.1111/joim.12752
- Bombaugh C. Maryanne, Chaoui A. Alain, Defossez Steven, Iliff R. Andrew, Jha K. Ashish, Miller R. Yael. A Crisis In Healthcare: A Call To Action On Physician Burnout. 2018. http://www.massmed.org/News-and-Publications/MMS-News-Releases/Physician-Burnout-Report-2018/
- Haas A. Derek, Halamka D. John, Suk Michael. 3 Ways To Make Electronic Health Records Less Time-Consuming For Physicians. January 2019. https://hbr.org/2019/01/3-ways-to-make-electronic-health-records-less-time-consuming-for-physicians
- Goldsmith Jeff, Wachter Robert. To Combat Physician Burnout And Improve Care, Fix The Electronic Health Record. March 2018. https://hbr.org/2018/03/to-combat-physician-burnout-and-improve-care-fix-the-electronic-health-record