Physician burnout isn’t getting worse, but that’s not exactly a win

Physicians say they are struggling with burnout, and spending time updating patient records on their “off hours” is contributing to the problem.

Many doctors bemoan the amount of documentation work they are doing in electronic health records after hours, or in what is dubbed “pajama time.” Researchers recently looked at some of the links between electronic health record documentation and the contribution to burnout among physicians.

Lisa Rotenstein, the lead author of the study and the medical director of ambulatory quality and safety at UCSF Health, said researchers looked at more than 10,000 family physicians between 2017 and 2023. They found a significant amount of burnout among those physicians. The study was supported by the Physicians Foundation.

“We found, first of all, that burnout has remained stable, and I don't think that that's a win,” she tells Chief Healthcare Executive®. “We've been working on this, and we haven't really seen burnout go down.”

“We've done a great job as a field of characterizing the impact on physicians, and I think that the next step is really, what we tried to do in this study, is through survey data, through experimental data, through observational data, try to identify what is it that healthcare leaders can do to alleviate these pressures,” she explains.

The study, which was supported by the Physicians Foundation, was published in Jama Network Open in November.

(See part of our conversation in this video. The story continues below.)

Looking at team efficiency

Much of the burnout is driven by the amount of hours doctors are documenting in electronic health records, she says. But she says the workplace also plays a role in the amount of time doctors are spending on documentation, and their levels of frustration.

“We know that time spent on the electronic health record is associated with burnout, and particularly when that time is spent after hours,” Rotenstein says. “And so that's why we did this study. We wanted to understand not only how does EHR time associate with burnout, but how does team efficiency associate with burnout.”

In their study, researchers also found links between physicians spending an “appropriate” amount of time on documentation in their off hours and reduced odds of burnout. Rotenstein says researchers found some factors that are tied to workers feeling less burnout and more satisfaction.

“Working with a nurse on your team was associated with greater odds of having an efficient team, in low home EHR time,” she says. Similarly, teams incorporating physician assistants were also found to be more efficient, and doctors experienced less burnout.

Those in independent practices also reported less burnout, and Rotenstein says there’s likely a lesson for health systems.

“There's probably a takeaway in there … even within a healthcare system, giving physicians a sense of control over their team and their work, such that they are perceiving that their teams are efficient, and their home EHR time is appropriate, that can be associated with these positive outcomes,” she says.

It’s worth noting that researchers said simply training doctors to use the electronic health record more effectively won’t necessarily reduce the amount of burnout.

“The reason that that's important is because many organizations emphasize the importance of EHR training and clinicians being really proficient on the EHR, and spend resources on that, and spend clinicians’ time on that,” Rotenstein says.

“But just being proficient on the EHR itself is not associated with less burnout,” she adds.

Many physicians find it difficult to simultaneously engage with their patients and try to document what they are saying.

“You want to be taking the time to look at your patient, to talk to your patient, to have that connection,” Rotenstein says. “And the real issue is that if you are in the room thinking about how you make sure you capture that last thing that was said, that little detail in the electronic health record, you just can't have that same connection. And that itself drives emotional exhaustion.”

As a result, she says many opt to focus on the patient first and then update records at home.

“We do pay attention because we want to and we need to, and then we go home and we do the charting after hours, we do the documentation after hours, and that is what has been shown to be associated with burnout, with intent to leave,” Rotenstein says.

Some health systems are turning to digital tools, including tools powered by artificial intelligence, to assist with documentation and streamline work for doctors. Rotenstein says AI-powered solutions offer potential to reduce stress on physicians, but the area needs more study.

Doctors are also spending more time answering emails sent via patient portals. Patients now have more ways to connect with doctors, and that can lead to better outcomes, but it can also add to stress and burnout among physicians.

Organizations may want to shift some of those messages to other members of the care team to serve patients and reduce the burden on doctors.

“We have this fine balancing act of trying to deliver this new type of care in a way that is sustainable for physicians,” Rotenstein says. “And I think ultimately, it comes back to teams, that the answer won't be the doctor themselves, but it'll probably be a group of folks supporting them, and supporting the care of the patients, such that we can achieve both aims. We can have better quality of care and satisfied patients, and have it be sustainable for doctors.”

• Read more: Doctors report high burnout, and low impact of wellness efforts

Lessons for health systems

Hospitals and health systems need to think about staffing and empowering doctors to focus on their patients, Rotenstein says.

“I think one of the roles of a healthcare leader is to sort of streamline the requirements that are coming at physicians and make it feel like at the end of the day, their job is to take care of the patient in the best way possible,” she says. “So ultimately, investing in the resources and the teams that allow that to happen is the best path forward.”

Smaller health systems and organizations can find ways to help their doctors, even if they have modest resources.

“We showed that higher team efficiency is associated with lower burnout,” Rotenstein says. “And that team doesn't have to be a team that is staffed with many, many people. That can be a team that works really well together and has worked well together over time, in which multiple team members feel valued.”

Researchers also found that physicians in value-based care organizations weren’t necessarily seeing less burnout, which Rotenstein says was unexpected. In fact, those doctors had pretty substantial documentation burdens.

“We have a sense that an organization being in a value-based care arrangement is often good for staffing and for team supports, and it likely is,” she says. “But it's also probably associated with increased documentation requirements and regulatory requirements that may additionally add to physicians’ workloads, thus changing their work experiences. So I was a little surprised by that.”

• Read more: Reducing burnout in doctors: Fix the workplace, not the worker