Emergency Medicine Physicians Seek Solutions to Burnout

February 1, 2016
Ed Rabinowitz

A new survey shows physician burnout is a particularly acute problem for emergency physicians. However, experts say the problem is not unsurmountable.

It was about a year ago that Geneia, a company that creates analytic and technology solutions to improve healthcare, released the findings of its Physician Misery Index, compiled from the results of a nationwide survey of more than 400 physicians.

The results, says Heather Lavoie, Geneia’s president and chief operating offer, were striking.

“We felt like physicians were increasingly expressing greater levels of unhappiness than we had heard in the past, but we were surprised at how extensive that was,” Lavoie says. “We didn’t expect to see how far the scales had tipped.”

Geneia responded by launching its Joy of Medicine Challenge, an online competition to solicit ideas from US licensed physicians on how to best restore the meaning behind the practice of medicine. When the winning physician turned out to have a background in emergency medicine, Geneia probed deeper with a second survey targeting more than 300 full-time emergency medicine physicians.

The results of that survey were even more disturbing.

Tipping the Scales

The initial survey revealed that two-thirds (67%) of surveyed physicians know a physician who is likely to stop practicing medicine in the next five years, as a result of physician burnout. This included both younger and more experienced physicians, and registered a 3.7 out of 5 on the Physician Misery Index.

“We found that most physicians still love medicine, but increasingly are frustrated by the business of medicine,” Lavoie says.

The follow-up survey indicated that emergency medicine physicians are even less happy, scoring 3.9 out of 5 on the index; 92% of them said that the “business and regulation of healthcare” has changed the practice of medicine for the worse. Two-thirds said they have considered career options outside of clinical practice as a result of burnout, compared with 51% of their colleagues.

Lavoie says the Joy of Medicine Challenge provided an opportunity for physicians to generate ideas; to get feedback and validation from their peers. And most importantly, it offered a ray of hopefulness amid the bleak survey results.

Advance Directives

Lavoie says that she and her colleagues were pleasantly surprised at the quality and quantity of the submissions in the Joy of Medicine Challenge, and the dialogue generated throughout the course of the program between judges, panelists and submitters.

One of the key insights to come out of the challenge and subsequent second survey was the importance emergency medicine physicians place on an advance directive. Ninety-three percent of those surveyed said they are less frustrated in cases where an advance directive is easily accessible.

Carrie Mendoza, MD, FACEP, an emergency medicine physician and judge for the Joy of Medicine Challenge, echoed the importance of the availability of an advance directive.

“As an emergency medicine physician, it’s not at all surprising to me that 100% of my colleagues said it is important to have an advance director in case of emergency,” Mendoza said. “Advance directives help improve satisfaction for patients, families and physicians.”

Lavoie explains that emergency physicians feel as if they don’t have a lot of information at their fingertips when a patient presents, particularly when a patient is unconscious. They’re grasping at information quickly, trying to determine what the right plan of care is for a patient in an emergency situation. And yet emergency physicians who don’t really have a long-standing relationship with patients are thrust into having those conversations at the moment.

“By having advance directives readily available to emergency physicians, the physicians would feel empowered,” Lavoie says. “They would feel that they were giving better and more appropriate care to patients, and that they would be better aligned with [the patient’s] values and the values of their family members.”

Financial Implications

Lavoie explains that with CMS aggressively moving in the direction of shifting reimbursement away from fee-for-service and toward quality of outcome and performance, emergency medicine physicians could see their pay impacted if they are unable to consistently provide appropriate care.

“It’s a little bit of a vicious cycle in terms of having to do more to sustain the existing compensation they have today,” she says. “If there are appropriate systems, if there are ways to help them facilitate that, if we change the workflow so that the documentation is done and they can focus on the treatment of patients, then they’re happier, and their compensation remains strong.”

Meanwhile, Lavoie and her colleagues are working with emergency medicine physicians to find and launch a broader solution on the availability of advance directives.

“Emergency department physicians nationally are looking at this as a major topic area in trying to resolve the issue of more advance directives, and how we might do that more systematically and make them more widely available.”