Few problems in health care are more vexing or persistent than physician burnout. It’s a problem that poses a serious threat to patient care, no different from the spread of a virus or the impact of cigarette smoke. And it has only gotten worse since the pandemic.
Burned-out physicians are less effective as healers. They don’t connect as well with patients, undermining the therapeutic benefits of a close clinician-patient relationship. They are also more likely to make clinical errors.
But today, in our health system, an estimated 42 percent of physicians suffer from burnout. Not only is this impacting health outcomes, but it is also causing a severe and worsening physician shortage, especially in primary care. Last year, nearly 30,000 adult primary care physicians (PCPs) left the practice of medicine. A growing number of exhausted physicians are cutting back their clinical hours, pursuing non-medical careers, or retiring prematurely. Addressing burnout and its causes is key to reversing the great migration away from patient care, preventing the current shortage from growing much worse. We are at a tipping point, and we need solutions fast.
The main drivers of burnout, especially for PCPs, are obvious: too many short, hurried visits; diminished professional autonomy; and an overwhelming documentation workload. Doctors are growing increasingly frustrated by a working environment that prevents them from delivering the best possible care to their patients. This all stems from a health care model that incentivizes the quantity of patient visits over quality. Physicians know they could be more effective healers, but the system obstructs them.
Until and unless the nation can move to a system that rewards value more than volume, efforts to reverse burnout are destined to fall short. Health care outcomes will continue to suffer as a result.
Let’s start with the problem of the shrinking physician visit. To keep up with the perverse incentives inherent to fee-for-service reimbursement, PCPs have been forced to cram more visits into office hours to make their practices economically viable (four short visits pay better than one long one). By contrast, physicians compensated on patient outcomes – keeping patients well and out of the hospital – do not need to see 25 or 30 patients per day to keep their practice running.
I work with physician groups across the country, representing more than 2,700 community PCPs, who have committed to 100 percent value-based care for seniors. The results have been dramatic. Our most effective partner physicians spend significantly more time with their highest acuity patients – and schedule fewer, longer visits each day. This has proven to be a much more satisfying way to practice. In fact, in these practices, we see a 95 percent annual retention rate.
Value-based care is a team sport. Rather than practicing in an individual and isolated manner, PCPs in value-oriented practices lead interdisciplinary teams consisting of social workers, pharmacists, care managers, and nurse practitioners.
Value-based care can also ease documentation requirements, a major driver of physician dissatisfaction. Under fee-for-service reimbursement, physicians are often forced to jump through hoops to justify billing requirements that have nothing to do with better care. In contrast, value-based care centers on capturing only essential data for improving patient outcomes, freeing up physicians to focus on patient care, even if there isn’t an associated billing code.
Physicians choose medicine because we want to make a difference in people’s lives. On my very first day of medical school, a professor welcomed us to this noble guild by saying the greatest thing a physician can be is useful. In a mature value-based care practice, everything – from scheduling to staffing configurations to patient outreach efforts – is designed to make doctors more useful, keeping patients healthy and independent.
We have lost our way in fee-for-service medicine; we can regain it through value-based care.
Ben Kornitzer is a physician executive.