By: Mona M. Abaza, MD, MS
M.M. Abaza is the residency program director and an associate professor in the Department of Otolaryngology at the University of Colorado School of Medicine. She is also a member of the Council of Faculty and Academic Societies (CFAS) Administrative board, and chair of the CFAS Faculty Resilience Working Group.
When I first read Rao et al’s article, which clearly shows the relationship of increased administrative burden, including electronic health record documentation, with faculty burnout, I was struck with a slightly incredulous feeling of “Well, isn’t that obvious.” Over the years of hearing Council of Faculty and Academic Societies faculty from all specialties and all parts of the country talk about the impact of administrative burden on their patient care, their job satisfaction, and their well-being, it seemed a fairly common theme to agree on and likely easy to prove its impact.
The article identifies women and primary care physicians as being at the highest risk. As a woman and a surgical subspecialist, I guess I am average. So what’s the problem, right? We all learn to cope, some better than others, some faster than others, and then we teach our residents that accurate and timely charting and all of the administrative tasks are for educational purposes, not service, since it will be at least 25% of their jobs. And isn’t this all just the reality of current regulations and systems that are improving our health care efficacy? Why fight it, right?
Physician burnout and lack of well-being is reaching crisis levels in academic medicine. From our trainees to ourselves, increasing depression rates and burnout, lack of career satisfaction, early departure from medicine, and other more terrifying aspects, like increasing suicide rates, are becoming part of our daily dialogue. What is obvious from the data is administrative burden is continuing to increase and that it has a very direct impact on burnout. No medical school admissions essay that I have ever read listed timely documentation and billing as an aspiration for a successful medical career. For my part, the ability to have a meaningful interaction with another human being while helping them is why I became a doctor. Accomplishing this is becoming harder with the exponential increase of administrative tasks that seems to fall disproportionately on the physician’s plate. While we all understand these tasks are part of the regulatory and financial needs of our current systems, the choice of either (1) having a more intimate interaction with the computer in front of you than the patient behind you or (2) spending the majority of your free nights and weekends working on documentation is truly becoming an unsustainable one.
One can argue though that physicians need to participate in the solutions to this issue, in particular, with counteracting the financial costs of fixing it. Rao et al’s article very clearly states that physicians are unwilling to be the ones to offset the potential costs of known solutions, such as scribes, etc. I imagine most of our institutions feel that these administrative burdens were created by regulatory changes they did not create. So why should the cost burden be theirs? On the other hand, I, like most practicing physicians, would argue that electronic health record systems have increased billing at the expense of the individual physician’s administrative burden, so that needs to be accounted for in the solutions. I anticipate the solution is more complicated than the options either of these points of view espouse, but I do think that an answer has to be a high priority for all of us. Our institutions need sustainable, well physicians that are able to provide the excellent patient care they want to deliver, and we need the institutional support that allows us to manage our many administrative requirements, while also allowing us to be the doctors we went into medicine to become.