Staying Sane as Medicine Goes Crazy

Shelly Reese

Disclosures

July 25, 2014

In This Article

More Factors Straining Physicians' Sanity

EHR Woes

Although electronic record-keeping has been a boon to efficiency in many fields, it has significantly increased physicians' workloads. In addition to the headaches associated with mastering new systems, doctors spend a lot more time on data entry and a lot less time looking their patients in the eye than they used to.

Consolidation

Whether they've gone to work as employees of larger groups or are struggling to remain autonomous, physicians are feeling the effects of market consolidation. Many employed doctors bemoan the loss of clinical autonomy and struggle to adapt to new corporate cultures. Meanwhile, their colleagues in independent practices must constantly struggle with making ends meet given their limited resources and competition from larger provider groups, which have the clout to negotiate better contracts with insurers.

Twenty percent of the 2000-plus physicians surveyed by Physicians Wellness Services (PWS) and Cejka Search as part of their 2012 Physician Stress and Burnout Survey were not employees -- a number that closely aligns with the 14.2% of respondents who cited "financial issues such as the cost of running a practice, debt, etc." as a major cause of stress.[2]

Staying Calm, and Keeping Your Spirits Positive

Daunting as these challenges may be, experts say physicians can chip away at them if they're willing to reconsider their practices and adjust to shifting demands. Here are some steps you can take now to help you stay in control.

Build a Team

Dr. Sinsky, one of six researchers who studied nearly two dozen high-functioning primary care practices for an article published in the May/June 2013 issue of Annals of Family Medicine[3] says teamwork lies at the heart of addressing many of these frustrations.

"We can't deliver the outcomes we want for the future with the practice model and the staffing model of the past," she says.

For instance, a physician who works with a part-time medical assistant or a different medical assistant every day can't optimally delegate responsibilities because the gap in their training and licensing authority is too great, which forces the doctor to deal with a lot of administrative work, Dr. Sinsky says. Working with a team of nurses or physician assistants enables physicians to build a more flexible staffing model, she explains, because doctors can delegate more and team members can share tasks depending on what's needed.

Here's an example of smart streamlining of tasks: "During flu season, you don't want a physician spending a lot of time putting orders in for over a thousand patients," Dr. Sinsky says. "That's a lot of clerical work. Instead they can have a standing order saying, 'Anyone who agrees to a flu shot can have one.'"

In the interest of saving time -- including your time -- it makes sense to draft written protocols for your staff, recommends Melissa Stratman, CEO of Coleman Associates, a Boulder, Colorado-based consulting firm that helps physicians redesign work processes. "Implement a couple of protocols a week. It will make employees' jobs more interesting and satisfying, and enable you to delegate. Discuss the protocols at staff meetings, and ask employees for their comments and suggestions," she says.

Use a Scribe

Having a cross-functional team means a team member can handle patient documentation for the physician, Dr. Sinsky says. Although some practices may opt to hire designated medical scribes, Dr. Sinsky says it's advantageous to train team members to do the work, so that a practice has the flexibility to use them in other capacities when needs arise.

Reengineer Tasks

Ordering routine tests before an office visit saves the practice time and promotes better communication with patients, Dr. Sinsky says. With results already in hand, you can discuss the numbers with your patients and use the exchange as an opportunity to motivate them, set goals, and develop an action plan. Ordering tests in advance likewise eliminates the need to call patients with their results after the visit. Similarly, by providing multimonth prescriptions for patients with stable conditions, practices can avoid repeating the same work multiple times throughout the year.

Simply taking the time to educate your medical assistants about what you need and why you need it can save lots of time and free up staff to handle more clerical functions, says Stratman.

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