American College Of Surgeons - Inspiring Quality: Highest Standards, Better Outcomes

Burnout crisis threatens medical profession (NL01)

OCTOBER 17, 2016
Clinical Congress Daily Highlights, Monday First Edition

The rate of burnout among physicians has reached alarming levels, making it one of the most pressing issues facing the medical profession, according to Delos “Toby” M. Cosgrove, MD, FACS, chief executive officer of the Cleveland Clinic.

Burnout among the general working public is about 28 percent, Dr. Cosgrove said in his Martin Memorial Lecture, “Doctors in Distress: The Burnout Crisis.” But among physicians that rate is now 54 percent and increasing. Today, more than a third of physicians say they would not choose medicine again if they had the choice, and 6 percent reported having suicidal thoughts.

“As health care changes, the rate of burnout is only increasing,” said Dr. Cosgrove. “It’s stressing physician interpersonal relationships, and leading to increased substance abuse and early retirement. And it’s harming our patients by increasing rates of medical error and contributing to poorer outcomes and decreased patient satisfaction.”

A number of factors have contributed to the dramatic rise in burnout, he said. Physicians have less autonomy and increasingly work in teams. At the Cleveland Clinic, for example, 120 people are involved in the care of a single cardiac surgery patient. Today only one-third of physicians are in their own practices, and only 5 percent of medical school graduates expect to be independent when they enter practice.

Physicians also face ever-increasing regulatory and reporting requirements. A recent study found that for every hour of clinical face time, physicians spend two hours on administrative duties, such as charting in electronic medical records. Much of this time is spent after hours and at home.

At the same time, physicians must keep up with the explosion in medical knowledge. Today there are more than 1,500 drugs in the pharmacopeia, more than 800,000 clinical trials being conducted and 5,600 medical journals that produce 806,000 articles annually.

“In the words of Abraham Lincoln, ‘We must think anew and act anew.’ As physicians we need to think of new ways to deliver health care that meet today’s challenges,” Dr. Cosgrove said.

The Cleveland Clinic has implemented a number of steps to address the burnout crisis. In the past year, Dr. Cosgrove led 140 town hall meetings and created the “Tell Toby” e-mail program to encourage discussion. He also has hosted 100 CEO meetings and his team has conducted 12,000 hours of one-on-one interviews.

Information gathered from these discussions has led to a number of new initiatives. In recent years, Cleveland Clinic has:

  • Hired more advanced practice providers to reduce the burden of new Affordable Care Act requirements. Cleveland Clinic now has 1,300 advanced practice providers, compared to 800 in 2010.
  • Reduced time spent with electronic health records (EHRs). At the Cleveland Clinic, 136 million e-mails were exchanged last year, including 3.5 million emails from patients. Support staff now responds to 60 percent of such messages. Physicians also have “tap and go” access to the EHR, reducing log-in time to just five seconds, and they can receive support from 37 IT staff members dedicated to the EHR. In primary care, scribes now support EHR input.
  • Increased the number of pharmacists supporting medication refills. On average medical doctors receive 1,000 refill requests per month, so the Cleveland Clinic has hired eight pharmacists to manage many of these refills. 
  • Instituted group visits for patient instructions. Diabetes patients, for example, will meet with an educator as a group to receive training and information about their care. Not only does this reduce the burden for physicians, patients also report that they enjoy interacting with each other.
  • Developed care paths to codify best practices. Today there are more than 100 care paths available, which have led to a reduction in cost and quality improvement.

Finally, Cleveland Clinic has increased the number of physician social events, launched Well Being Day, and implemented “Code Lavender,” which delivers counseling or other services when a staff member needs emotional support.

“During my career I became an accomplished technician, but surgery is much more than that,” said Dr. Cosgrove. “It is a privilege to care for people at their most vulnerable time. Fundamental to our profession is caring about our patients. As Theodore Roosevelt said, ‘No one cares how much you know until they know how much you care.’”

Additional Information:

The Opening Ceremony/Martin Memorial Lecture, was held October 17 at the American College of Surgeons Clinical Congress 2016, in Washington, D.C. (program, webcast and audio information).