Physician Burnout Is Not Just Due to EHRs

Electronic health record (EHR) design and use factors are often strong contributors to physician stress and burnout. But non-related issues, especially work conditions, play a significant role in adverse physician outcomes, according to a recent study published in JAMA Network Open.

Nearly 75% of physicians said time pressure for documentation are a cause of stress and burnout, according to the paper. Overall, half (50.4%) felt they had overall insufficient personal time.

Fewer than 34% said their practice emphasized work-life balance, while 76.2% said productivity was overemphasized.

Some 60.2% spent moderately high or excessive time on the EHR at home.

Excessive data entry requirements (86.9%), long cut-and-pasted notes (75.2%) and inaccessibility of information from multiple institutions (73.1%) were the most prevalent concerns physicians reported about EHR design and use.

EHR design and use factors accounted for 12.5% of variance in measures of stress and 6.8% of variance in measures of burnout.

To better understand the contributors to physician stress and burnout, physician focus groups at three institutions, Stanford Hospital and Clinics, University of New Mexico and Centura Health Physician Group, identified design and use factors that were successful. The physicians also identified factors associated with user stress, burnout and unintended physical symptoms.

The design and use factors identified from the focus groups led to the design of a survey instrument which included questions from previously validated instruments to measure stress burnout and other challenges. Questions also focused on workplace characteristics like workload control, atmosphere, patient complexity and organizational culture.

The survey attempted to determine:

• Perceived EHR successes
• EHR design and use factors associated with clinician stress and burnout
• Perceived adverse personal outcomes, like pain or anxiety
• Things that could improve the EHR experience, like greater staff support, fewer click and scribes
• Coping strategies, such as exercise or setting boundaries

Physicians and advanced practice clinicians, including nurse practitioners and physician assistants, came from five disciplines: general internal medicine, medical subspecialties, general pediatrics, pediatric subspecialties and family medicine.

Of the 640 clinicians surveyed across three institutions, 44.1% responded. Researchers saw no significant differences in mean burnout between clinician or practice types.

In addition to excessive data entry, EHR design and use factors significantly associated with high clinician stress were information overload, slow system response times, inability to quickly navigate the system and interference with the patient-physician relationship — among other things.

Non-EHR related factors associated with high levels of stress included control of workload, office atmosphere, time for personal and family life and time for documentation at work.

Interference with patient care and inefficient systems accounted for 52.2% of the variability in EHR design and use.

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