The pajama practice is another recent addition to physician’s work day; this is the time they spend logged into their EMR system from home to clean up unfinished documentation before retiring. For today’s physicians, time pressures and loss of professional control are the two top contributors to their escalating stress and burnout, not to mention the erosion of time available for family and personal activities.9
What May Help
It is a given that the U.S. needs an effective, highly motivated physician workforce. Any hope of achieving this requires the policymakers, payers and administrators to support physicians’ refocusing their time and attention on high-value care. This will require implementing and funding more efficient and effective delivery teams and processes at the points of service, including a return to value-based medical record keeping and financial incentives that promote value rather than volume. Also, the assessment of physician performance should be returned to structured peer review, as in the past, rather than the current monitoring by administrators and payer clerks.
This practice redesign must begin with shifting work from physicians to others whenever possible, or omitting it entirely, because few have the time now to even consider how they might make things better. Revenues must be used to support increased practice staffing and resources rather than increased administration. Billing must be based once again on the time, effort and complexity of services provided, as estimated by the physician, rather than on the volume of documentation. Administrative review should be restricted to outliers rather than being imposed on all physicians by growing bureaucracies.
Most importantly, physicians must regain control of how they spent their time in their patients’ best interests, and they must be rewarded for maximizing their practices’ efficiency and effectiveness. In the end, team care actually pays for itself by increasing the number of patients managed per physician and decreasing the costs of care per patient.
The American Medical Association, the National Academy of Medicine, the medical licensing boards, the alphabet soup of professional organizations and the large-practice administrations all appear to have accepted high-volume medical records, growing administrative and regulatory burdens, and low-value care as immutable realities. They are embarking on multiyear studies to better understand physician burnout when the root causes—time pressures and loss of control—are in plain sight, as are the solutions.10
It is way too easy for health system stakeholders to protect their advantages by continuing to add widgets to physicians’ workloads and expand their EMRs in the name of improvement. They must instead recognize and address time compression and loss of control as the root causes of degraded physician performance and well-being.
