Becker’s ASC Review recently spoke with two experts from Modernizing Medicine Gastroenterology about physician burnout and best practices for dealing with this serious problem:
- Julie Servoss, MD, MPH, Senior Medical Director of Gastroenterology
- Jason Sugar, MD, Lead Gastroenterologist
Everyone experiences burnout differently, but neglecting self-care is a common root cause
Physician burnout is so widespread that most physicians have experienced it at some point in their career, either during their medical training or during practice. Dr. Servoss is one of those practitioners who understands burnout on a personal level.
“I experienced a period of burnout near the end of my fellowship training in gastroenterology, when I was doing clinical research and getting my master’s degree at the Harvard School of Public Health in clinical effectiveness,” Dr. Servoss said. “I was augmenting my skillset and experience not only as a gastroenterologist, but also as a clinical researcher. Concomitantly, I had two kids under the age of two. Trying to holistically manage my career and my personal life proved to be too many tasks and too many balls up in the air.”
Burnout often leads to depressive symptoms. During Dr. Servoss’ episode of burnout, she didn’t derive the same amount of joy from spending time with her husband and children. “I was exhausted, distracted and thinking about the next thing I had to do,” she said. “I was unable cognitively, physically and emotionally manage all the things I had put on my plate.”
Dr. Servoss has found that neglecting self-care is one of the root causes of burnout. When physicians are faced with a heavy burden of urgent tasks, they are constantly extinguishing fires in either their professional or personal life. Self-care is usually one of the first things they sacrifice. “You can always put off self-care, because it only impacts you,” Dr. Servoss said. “People tend to put themselves last and that was certainly the case for me.”
Self-care means taking a holistic approach to health and wellness, which includes eating well, getting enough sleep and exercising. Neglecting self-care can turn into a vicious cycle. When people don’t take care of themselves, it creates more stress and depressive symptoms. The psychological impact of not having an integrated, harmonious work and life situation leads to feeling imbalanced and unwell.
“You need to make time for leisure activities, exercise, a good diet and sleep,” Dr. Sugar said. “I think it’s important to carve out time for yourself and to spend time with your family. Physicians need to maintain a healthy lifestyle whether they are in a pandemic or not and whether they have burnout or not.”
Setting boundaries enables physicians to “say no and protect their yes”
To support greater well-being, Dr. Servoss recommends physicians take time to prioritize their goals, whether it’s productivity in their practice or other things they value.
“You actually have to assign value to the things that are important in your life,” Dr. Servoss said. “Only you can identify that. Then you start saying no to the things that aren’t in your set of values or goals. That can be very difficult for high-achieving professionals like physicians. It’s hard to say no because we are called to give and care for others. But in my mind, saying no actually protects my yes; I protect my time for the things I value most.”
Boundary-setting applies to physicians’ practice settings, as well as to their personal lives. The key is to be proactive about managing time and aligning work with personal and professional goals.
“Physicians often have this urgent desire to build their practices when they’re first starting out,” Dr. Servoss said. “I’ve seen this in my colleagues and in myself. Your office schedule might be 8:30am to 6:00pm. Then all of a sudden, you’re trying to see new patients, and you start coming in at 8:00am instead. Now, in the era of COVID-19 and telemedicine, work can bleed even more into the remaining hours of the day. We have to be mindful of that.”
In addition to the increased use of telemedicine, the pandemic has introduced new practices like donning PPE for face-to-face appointments and frequent temperature checks. It’s important to recognize that all of these small shifts can create added burdens for physicians.
“Gastroenterologists perform a lot of procedures,” Dr. Sugar said. “As we have returned to practice, we’ve been sure to schedule breaks throughout the day for staff. This gives them a few minutes here and there to remove their masks. I think that’s important.”
Technology solutions can reduce physicians’ cognitive load
The administrative burden associated with practice management can be significant, whether it’s dealing with insurance companies, submitting payments, dealing with pharmacies and more. When the elements of practice management are efficient and smooth, however, physicians feel less stress.
“If electronic health record systems, practice management systems and patient engagement tools are designed correctly, it reduces the cognitive load on physicians related to urgent tasks like obtaining prior authorization for biologics and other medications and dealing with documentation surrounding patient care,” Dr. Servoss said.
To address these needs, Modernizing Medicine Gastroenterology has created all-in-one, integrated solutions that include practice management, revenue cycle management, health records, e-prescribing and ASC procedure documentation. Clinicians can also access medical records on their mobile devices, so they can pull up patient charts at the hospital or wherever they are.
“Having an electronic medical record that’s integrated and allows you to communicate easily with patients, nurses, the front-desk staff or billers makes workflows more efficient,” Dr. Sugar said. “A patient portal that supports easy communication of all kinds also decreases the administrative burden that can lead to increased burnout. It’s possible, for example, to automate patient reminders and recalls.”
Technologies that support efficiency in a physician’s practice can help reduce physician clinical burden. “With the right technology, physicians are free to use their brains for thinking about patient care,” said Dr. Servoss. “That’s really what physicians want — tools and technology to help reclaim their time with patients.”
Telehealth also has the potential to improve efficiency
COVID-19 has highlighted the operational viability of telehealth. Virtual care solutions are new tools in physicians’ armamentarium. Practices can use and flex telehealth systems to meet their needs and those of their patients. To provide value and reduce inefficiencies, however, organizations must deploy telehealth with care.
“I think of telemedicine as a double-edged or even a multi-edged sword,” Dr. Servoss said. “Providers aren’t sure that telemedicine can serve all patient needs in the best way possible. Most say that it’s a beautiful tool for seeing existing patients that are relatively stable for follow-up. It can help prevent burnout. I no longer have to drive half an hour to my office. I feel comfortable logging in from my home and having a video conference with a patient I already know. Right now, I see all my patients via telemedicine, and it’s been helpful.”
Telehealth isn’t a silver-bullet solution for all situations, however. In some clinical scenarios, a physical examination is the only way to successfully diagnose a patient’s condition. In the virtual care setting, physicians can do a workup and think about potential diagnoses, but they are limited. Patient and physician preferences also play a role. Some are also more comfortable seeing one another face-to-face, rather than using telehealth applications.
Despite these issues, virtual care solutions can increase physician productivity, while also increasing patient access to care. Dr. Servoss noted, “Telemedicine could potentially result in a more efficient practice. Seeing more of my followup patients with chronic disease via telehealth could allow me to dedicate more time in the office to seeing acutely ill patients or perhaps even new patients.”
As the COVID-19 pandemic continues, healthcare organizations must remain vigilant about physician well-being
Certain regions of the United States are now seeing light at the end of the COVID-19 tunnel. In those places, businesses are reopening and doctors are resuming face-to face visits with patients. For people worldwide, however, COVID-19 has had significant mental health consequences. These have been particularly acute for physicians.
“I think in the United States and elsewhere, we must be mindful of the global physician population and the strain that the pandemic has put on these professionals,” Dr. Servoss said. “When people feel uncertainty and a lack of control, that exacerbates burnout. I don’t believe that COVID-19 is the last virus we’ll see that results in a pandemic and lockdowns. Looking ahead, we need to be proactive in thinking about our healthcare systems, how we deliver care and how physicians will survive the next round. Technology has to be one of the answers.”
This article was sponsored by Modernizing Medicine Gastroenterology.
