As we move into 2018, burnout continues to be a burning topic in the medical community. The American Medical Association (AMA), other healthcare organizations, and US based medical transcription outsourcing companies are focused on reducing burnout among physicians while helping them improve patient care. According to a recently published AMA report, team-based care could be an effective solution for the underlying causes of physician burnout.
The article describes how the shift to a team-based model improved physician well-being at a Wisconsin primary care practice. “Team support has made practicing medicine fun again and much more fulfilling,” says the family physician.
The new model includes a core team of two medical assistants (MAs) or licensed practical nurses and one half nurse per physician, as well as an extended care team of case managers, diabetic educators, clinical pharmacists and RN care coordinators. The medical assistants serve as scribes, and handle electronic health-record documentation, entering pending orders, referrals and more.
The issue of physician burnout attained unprecedented proportions in 2017. According to one report that looked into a Medscape survey that rated severity of burnout by specialty, emergency medicine was the most affected. Up to 60 percent of ER physicians said they feel burned out.
In another report, a healthcare couple discussed the benefits of going part-time. Some of the reasons driving physicians reduce their work hours include stress, bureaucracy and the feeling of missing out on one’s personal life. On the other hand, making the switch to a lighter workload was not easy considering hurdles such as medical school debt, career goals and pressure from employers.
Winning the battle against physician burnout has become especially critical in the light of the findings of a new study published in Mayo Clinic Proceedings that quantified the potential impact of professional dissatisfaction on the physician workforce and patients access to care. The study, based on a nationwide survey of 7,000 physicians from all specialties, found that
- One in five physicians intends to reduce clinical work hours in the next year (2018)
- 6 percent of those looking to reduce work hours said the primary reason for doing so was to get more ‘family time’
- 2 percent reported frustration with Medicare and insurance issues or dissatisfaction with the work environment as the main reason for cutting down time at work
- Roughly one in 50 physicians plans to leave medicine for a different career in the next two years
The study estimates that nearly 4,800 physicians would leave the workforce if just 30 percent of physicians stick to their intention to leave medicine in the next two years.
Team-based care could be the panacea for physician stress. In fact, AMA reported last year that practices across US have been implementing team-based care models to optimize use of the skills and training of the care team and also streamline office procedures. The report explains the various elements of the team care model and how they are combined.
- Pre-visit preparation: The first element of team-based care involves pre-visit activities. This involves ensuring that patients are prepared for the visit, The best approach is to plan for the next consult at the end of the present visit. Prior to the appointment, a nurse, medical assistant (MA) or other team member can be designated to complete the pre-visit planning activities two or three days before the visit. This would include:
- Reviewing notes from the previous visit and ensuring follow-up results are available for physician review
- Using a visit-prep checklist to identify any care gaps or upcoming preventive and chronic care needs
- Checking if any other information such as hospital or emergency department notes is needed for the consult
- Sending automated appointment reminders to patients
- Ordering labs ahead of time so that the results will be available before the next appointment
Team members collaborate at the beginning of each day to review the schedule and discuss items important to all team members.
- The office visit: All members of the care team contribute to improving and streamlining the patient visit. The nurse or MA first updates the medical record and obtains an initial history. Next, the nurse, MA or documentation specialist helps the physician document the visit. At the end of the visit, the team member educates the patient on the plan of care and the importance of adherence. As the care team becomes more knowledgeable and involved in the treatment plan, they can coordinate care between visits more effectively and build closer ties with patients and their families.
Practices can adopt various strategies to support this process such as expanding rooming and discharge protocols, implementing team documentation, and using annual visits to modify prescriptions. Each visit should end with planning for the next visit.
In addition to the care model approach, EHR-integrated medical transcription services continue to be an effective support strategy for family care practices. Trained and experienced medical transcriptionists can provide accurate and timely documentation support for not only family care but also all other specialties. New payment models encourage providers to optimize use of their manpower and resources while avoiding unnecessary services and costly errors. A team approach can promote more efficient use of resources, improve care, reduce physician stress and restore joy to the practice of medicine.