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Burnout among physicians and advanced practice providers (APPs) is one of the most critical issues in healthcare.

Roughly half of these professionals reported at least one burnout symptom, such as emotional exhaustion and detachment from patients, in a Mayo Clinic survey. 

When burnout strikes, a health professional’s ability to provide quality care is diminished, and the likelihood of a safety mishap or medical error rises. Physician burnout costs the U.S. health system approximately $4.6 billion annually in turnover, reduced productivity and other costs.

Case Study

Across-the-Board Impact of an OB-GYN Hospitalist Program

A Denver facility saw across-the-board improvements in patient satisfaction, maternal quality metrics, decreased subsidy and increased service volume, thanks to the rollout of the first OB-GYN hospitalist program in the state.

See how

In extreme cases, burnout leads to suicide. A physician commits suicide every day in this country—twice the national average. The trauma of a colleague’s suicide has touched the lives of most U.S. physicians and APPs.

Years ago, a colleague of mine committed suicide—and I still wonder if that could have ended differently, if attention were focused on this problem like it is now, if a support network was in place and if we had understood more about stressors and how organizations can help reduce them.  

We ask physicians and APPs to be productive and efficient, to prevent safety mishaps and medical mistakes, to provide incredible care despite grueling schedules and to do all this at an affordable price. Documentation and complex new technologies add to this already significant burden. 

We did not get here through a single cause, and no single solution will fix it. Burnout is a constellation of symptoms, requiring a multipronged strategy. A leading voice in this effort, Stephen Swensen, M.D., professor emeritus, Mayo Clinic College of Medicine and Science, created a holistic model to combat burnout. 

At Banner Health, our burnout strategy—Cultivating Happiness in Medicine (CHIM)—is based on that model, tailored for a large, multistate health system. It includes incorporating burnout into our enterprisewide operating plan and strategic initiatives, annual measurement and designating a team to oversee these efforts.

As part of CHIM, for example, we have a support program for “second victims,” providers involved in an adverse patient event or injury. Recognizing second victims in no way lessens the focus on the patient, but it is essential to help professionals recover and to learn and acknowledge what was their fault and what was not, to help them be ready for other patients who need their help.

Measurement is also essential. We previously used surrogate measures of physician/employee engagement: is this a great place to work, a great place to receive care, etc. In 2018, we began more specific measurement using the Maslach Burnout Survey. From 2017 to 2018, we saw 60% improvement in physician engagement, 36% less physician turnover and 46% improvement in electronic health record speed.

Our experience, over the last 18 months, gives me great optimism.

But the call to action applies to all of us: A decade from now, physician burnout should be rare. We owe it to clinicians to build workplaces where they can thrive and focus on the mission of healing that brought them here. 

Marjorie Bessel, M.D., chief clinical officer for Phoenix-based Banner Health, has made ending physician burnout her top priority.

Tom Catena, M.D., has been described as ”the world’s most important doctor,” and he is, to more than a million patients.

That’s because the 55-year-old American doctor is the only surgeon for 1.3 million people in the Nuba Mountains of Sudan—a region nearly twice the size of Massachusetts. A Catholic medical missionary in a region torn apart by war, he was just awarded the annual Gerson L’Chaim Prize for “outstanding Christian medical missionary service” from Florida-based nonprofit African Mission Healthcare.

Case Study

Across-the-Board Impact of an OB-GYN Hospitalist Program

A Denver facility saw across-the-board improvements in patient satisfaction, maternal quality metrics, decreased subsidy and increased service volume, thanks to the rollout of the first OB-GYN hospitalist program in the state.

See how

The international medical missionary prize comes with a $500,000 award—money Catena plans to use to cover some of the running costs of his hospital and to help establish a school to train nurses, midwives and clinical officers (the equivalent of physician assistants in the U.S.).

“The $500,000 goes a long way here,” Catena said via email to FierceHealthcare. “We feel the school is key to just start creating a cadre of trained Nuba health professionals.”

Tom Catena, M.D., with a mother and young child
(African Mission Healthcare)

Catena, who grew up in upstate New York, has served in Africa for more than 20 years. Since 2008, he has practiced in Gidel in the Nuba Mountains, living in the middle of the war-torn and besieged territory, which is fiercely contested by its inhabitants and the former government of Sudan.

“The two things that keep me here are the toughness and resilience of the Nuba people and what I see as my role as a medical missionary,” he said.

“My role is simply to show the love of Christ to others and that can only be done by sticking it out during the times that are most difficult.”

In 2011, when the fighting started in Sudan and the capital began bombing its own people in the southernmost region, all of the other expatriate workers in the country left, he said. It was the missionaries who stayed with the people.

Catena was among those who insisted on staying. A graduate of Duke University Medical School and a former U.S. Navy doctor, Catena has been the medical director at Gidel Mother of Mercy Hospital, which he helped establish.

The 435-bed Catholic hospital is the only major medical facility in the Nuba Mountains, and Catena is on call 24/7, sometimes seeing as many as 350 or more patients in a single day.

At one point subject to bombings by Sudanese fighter jets, the hospital compound now has several foxholes where patients and staff can flee in case of more attacks.

A deserving recipient

The L’Chaim (Hebrew for “to life”) Prize is sponsored by Jewish philanthropists Rabbi Erica and Mark Gerson.

“Dr. Tom Catena has given up everything that we in the U.S. take for granted in order to bring healthcare to more than a million people who, without him, would otherwise not have access to any medical care,” said Mark Gerson, co-founder of African Mission Healthcare, which has been supporting mission hospitals in Africa since 2010, in an announcement about the 2019 award.

The L’Chaim prize, launched in 2016, comes with the world’s largest annual award of its kind dedicated to direct patient care in Africa. Catena will receive the award April 14 at a dinner in New York City.

“For more than a decade, Tom has endured bombings, epidemics, rainy seasons and flooding, loss of power, lack of equipment and staff, and very little connection with the outside world, all because of his dedication to the Nuba people. He exemplifies what it means to ‘walk in all God’s ways and to love Him,’ and we are honored to be his partner in his sacred work,” said Rabbi Erica Gerson, who co-sponsors the prize with her husband.

The $500,000 award will go toward the Nuba 2020 campaign, the goal of which is to raise $7.5 million to keep the only major hospital in the Nuba Mountains fully operational for the next two decades. The money also will help strengthen and expand the hospital and its network of clinics, Catena said.

Mark Gerson commented on Catena’s commitment. “The sheer amount of good he does—as measured in clinic visits, surgeries, deliveries, community clinic patients treated, and children vaccinated—with the amount of resources he has is completely stunning. It is simply incredible to even think about how many lives Tom and the team he has built can save and transform with the money that he is provided,” he said.

A challenging place

Catena, who has also had his face on a 2018 Armenia stamp after he was awarded the second annual Aurora Prize for Awakening Humanity, said he was pleasantly surprised to receive the L’Chaim prize.

“The previous awardees had pretty major accomplishments,” he said. “The prize money will give us a big boost and hopefully help to put us on some solid financial footing. We are completely dependent on individual donors yet are the only major referral hospital for a population of over one million.”

Tom Catena, M.D., with his wife Nasima,
a nurse (African Mission Healthcare)

Catena said it is the people who have kept him in Africa. He recalls a young girl, who was about three or four years old and was being cared for by her elderly grandmother. The girl’s mother was killed in an airstrike by the Sudan Air Force, and the grandmother was struggling to look after her. 

“When the girl came to us, she was skin and bones and unable to walk due to TB of the spine. With TB medicines and good care by our nursing staff, the girl was restored to full health,” he said.

His advice for other doctors? “Working in these remote and challenging settings can be very frustrating yet incredibly rewarding,” he said.

But it’s work he recommends others try. “I’d recommend anyone to do perhaps a short-term mission to see if it’s for them and then something more long term, where they would be able to contribute more.”

Federal regulators have listened to physicians’ complaints about health IT burdens and they have some solutions.

The Department of Health and Human Services (HHS) released Friday a final version of an overarching strategy to reduce clinician burden revolving around entering information into the electronic health records (EHRs), meeting regulatory requirements and improving EHR ease of use.

The new report (PDF), which includes 43 recommendations around clinical documentation and health IT usability, is a follow-up to a draft strategy released in November 2018.

Case Study

Across-the-Board Impact of an OB-GYN Hospitalist Program

A Denver facility saw across-the-board improvements in patient satisfaction, maternal quality metrics, decreased subsidy and increased service volume, thanks to the rollout of the first OB-GYN hospitalist program in the state.

See how

The overall goal is to improve patient care by enabling physicians to spend more time focused on them instead of their keyboards, HHS officials said.

“Physicians and other healthcare providers have long identified regulatory and administrative burdens as a key contributor to the many challenges they face. They also note these burdens weigh down the overall healthcare delivery system as well. Clinicians have pointed to an ever-increasing and poorly coordinated set of requirements they must meet to deliver and receive payment for patient care,” senior officials with the Office of the National Coordinator for Health IT (ONC) wrote in a blog post Friday.

The clinical community frequently links the increased burden of meeting these requirements with the tasks and use of health IT, such as EHRs, Andrew Gettinger, chief clinical officer for ONC, and Thomas Mason, ONC’s chief medical officer, wrote.

The report targets burdens tied to regulatory and administrative requirements that the federal government can directly impact through the rule-making process.

When looking at the steps HHS could take to mitigate EHR-related burden for healthcare providers, ONC and the Centers for Medicare & Medicaid Services (CMS) focused on strategies that are achievable within the near to medium term, roughly a three- to five-year window, according to the report.

And HHS is looking at strategies it can implement through existing or easily expanded authority.

EHR burdens have been a near-constant complaint from physicians that see the technology as an impediment to their relationship with patients. Numerous studies have documented the time suck of the technology.

The finalized strategy, required under the 21st Century Cures Act, reflects feedback from industry stakeholders and healthcare groups, including 200 comments submitted to the draft strategy, HHS said.

In several recommendations, the agency vowed to continue its work stripping down regulations and working with the industry to find solutions to growing problems. 

CMS already has taken some steps to reduce administrative burden such as changes to the more-than-two-decades-old E/M documentation and coding framework that clinicians use to bill Medicare for common office visits. 

HHS also wants to see health IT vendors doing more to improve technology usability. EHR vendors need to work with clinicians when designing systems or new features and should consult with experts in user-centered design during development, HHS officials said.

Specifically, EHR vendors should take the lead in developing health IT-specific user interface best practices and should collaborate to develop a shared repository of EHR usability practices.

This collaboration would help provide better consistency with user interface best practices while still enabling EHRs to compete with each other, HHS said in the report.

HHS also wants an EHR vendor’s user-centered design process to be highlighted on the ONC Certified Health IT Product List so potential EHR customers can see the efforts that went into the products they are considering acquiring.

“A shift from check-box interface elements to intelligent features that extract needed data from routine clinical workflows would provide a substantial reduction in usability-related clinician burdens,” HHS officials wrote in the report.

HHS’ recommendations represent the “best next steps” to address the growing problem of clinician burden related to their use of health IT and EHRs, ONC chief Donald Rucker, M.D., said in the report.

As part of its ongoing strategy, ONC plans to work to enable further automation in healthcare, with a focus on prior authorization and quality reporting.

“Through this HHS strategy, we look forward to advancing the premise of how to accurately model and support the clinical cognitive process in the EHR—a shift away from a strictly linear, logic-based model to a more sophisticated design that supports the complex pattern recognition inherent in the diagnostic and treatment process,” Rucker said in the report.

“We envision a time when clinicians will use the medical record not as an encounter-based document to support billing, but rather as a tool to fulfill its original intention: supporting the best possible care for the patient.”