This is a difficult time for everyone involved in healthcare, whether provider, management or government. Financial and clinical stress is sky high. In a time of diminished revenue, valuable resources are required for crisis management, protection of providers and patients, and rapid redesign around outpatient care delivery and telemedicine. “Bandwidth”, the popular term meant to recognize the limits of organizational capacity, is severely stressed.
In such times, it is easy to succumb to the temptation of short-term thinking and decision making, losing our compass for the future. This is especially true as regards our physicians and nurses. We are at great risk of exacerbating an evolving crisis of widespread burnout, inadequate provider capacity to provide care, and a decline in overall morale and clinical safety. While this article is focused on physicians, and by extension advanced practice clinicians, the issues are much the same for nursing, which will be covered in a subsequent post.
A MGMA StatPoll in May of 2020 showed 82% of healthcare leaders reported reductions in provider compensation, including reducing hours and salaries, limiting CME, or reducing / eliminating bonuses. In late June of 2020, the Primary Care Collaborative surveyed primary care physicians and found that fewer than 50% of practices report having enough cash on hand to stay open, over one-third have laid off or furloughed staff in the last 4 weeks, and 53% report that patients are not scheduling well visits or chronic care visits despite their availability in the practice.
For a self-employed physician group, these are devastating statistics, placing them at high risk for closure or sale to a larger organization. Add to this that CMS may terminate payments for telemedicine when the national emergency is over, and the cash flow issues worsen.
The measurement of burnout in the Collaborative survey found extraordinary levels of stress and burnout. 38% of practices said burnout was at an all-time high, and 70% rated the level of strain on their practice as 4 or 5 on a 5-point Likert scale.
38% of practices said burnout was at an all-time high, and 70% rated the level of strain on their practice as 4 or 5 on a 5-point Likert scale.
Of course, the major concern for doctors is always about their patients. They are seeing higher stress, anxiety, and depression in patients who come in for care, and are concerned about their vulnerable, chronic patients who are not receiving care, and the inability to provide basic preventive services. Particularly for primary care physicians, frustration with and worry about delayed care is extensive.
Our most recent survey findings at SE Healthcare from a large number of self-employed physicians and advance practice clinicians confirm these findings. Comments about primary stressors include:
“As an independent physician --saving my practice. Our numbers are down, we had to lay off staff. I had to apply for a PPP loan. We're worried about when we'll be able to see patients back in the office. I am working crazy hours both seeing patients via telemed and figuring out the administrative side of things.”
“Concern about the financial stability of the whole organization as a consequence of the pandemic and as well as whether we will able to survive this financially.”
“Trying to maintain my independence and the costs of being a solo practitioner.”
“Decisions going forward about the future of my practice and whether to remain in private practice or to change to an employed model” - all of which reinforce the anxiety, stress, and worry about practice viability.
There are long-term consequences to allowing this situation to evolve without intervention. A recently released physician workforce projection by the AAMC estimates that we could see a physician shortage of between 54,000 and 139,000 physicians by 2033, an increase in demand from prior surveys.
In addition, their surveys reveal higher numbers of physicians planning to retire early amid significant levels of burnout pre-COVID19. Absent intervention, If our physicians continue to burn out at these historic levels now seen during the pandemic, there are two scenarios equally problematic for healthcare systems and their patients.
First, of course, is that the trend to early retirement or career change is accelerated by the stress of the pandemic, and the shortage of physicians is exacerbated with profound implications for access to care.
Equally problematic is the scenario in which the economic circumstances cited above result in delayed retirement by burned out physicians purely for economic reasons. Physicians experiencing burnout have been shown to make more mistakes, be less productive, and have lower patient satisfaction than their peers. Without intervention, physicians working joylessly in delayed retirement is not a benefit to either the practice, health system or to our patients.
Now is not the time to delay or postpone active, proven interventions and programs to help our physicians avoid, recognize, and manage burnout. Now is also not the time to stop listening to our doctors, understanding their issues and supporting and engaging them in solving the urgent issues we face.
Waiting for more “bandwidth” until our doctors are a mere shadow of themselves from dealing with almost unmanageable personal, professional, and financial strain is a huge long-term mistake.
Organizations who act today by supporting physicians with resources, care, policy, and work improvements grounded in powerful tools for listening will be far ahead of others in the years to come. Investing now will create future yields of higher quality, access, and satisfaction arising from healthy caregivers. Don’t be caught in the trap of short-term thinking. This is one investment you must make. Now.