Hospitalists’ struggles with the promise and pitfalls of the electronic health record (EHR) can also impinge on their personal satisfaction with their jobs.
The EHR has been identified as a major contributor to physician burnout. Research conducted in 2013 by the RAND Corporation and the American Medical Association (AMA) identified EHRs as the leading cause of physician dissatisfaction, emotional fatigue, depersonalization, and lost enthusiasm for the job.1 The MEMO study found that increased numbers of EHR functions in primary-care settings were associated with physician-reported stress, burnout, and desire to leave the practice.2 Daniel Roberts, MD, FHM, and colleagues found that more than half of hospitalists (52.3%) were affected by burnout, although rates were not higher than in outpatient settings.3
“It’s not fair to blame all physician burnout on the EHR, but the EHR has enabled others to place new demands on physicians and their practices,” says Christine Sinsky, MD, a former hospitalist and current vice president of professional satisfaction for AMA. “The current state of EHR technology appears to worsen professional satisfaction in multiple ways, resulting in reduced face time with patients and more time spent on data-entry functions.”
Dr. Sinsky says her association is trying to address the problem, both with advocacy to delay or revise government requirements for EHR adoption and through its STEPS Forward initiative to help physicians and their staffs redesign medical practices to minimize stress in a changing healthcare environment.
The AMA/RAND research did not break out hospital medicine specifically, although it identified high rates of job dissatisfaction for internists.
Jonathan Pell, MD, hospitalist and assistant professor of medicine at the University of Colorado in Denver, says more research is needed to connect the dots between the EHR and hospitalists’ job satisfaction.
“It makes me wonder, does the EHR affect hospitalists differently than it does outpatient doctors?” he says. “More hospitals and health systems are starting to survey physicians regarding their job satisfaction.”
Dr. Pell also points to computerized physician order entry as a related contributor to job stress.
What Can the Hospitalist Do?
“I’m a believer in the EHR,” says R.J. Bunnell, MD, hospitalist at the 321-bed McKay-Dee Hospital in Ogden, Utah, and physician champion for EHR implementation at Salt Lake City–based Intermountain Healthcare. “We have the potential to reduce medical errors and decrease the burden on physicians, eventually providing unique decision support tools.”
Dr. Bunnell says many of the issues with EHR stem from the complex designs of the systems and cumbersome data collection.
“The practice of medicine is getting more complex year by year, with more regulatory oversight and well-intentioned—but poorly designed—mandates,” he says. “Physicians spend less one-on-one time with their patients and feel they no longer have power over their jobs.”
Dr. Bunnell helped plan implementation of the Intermountain EHR, including its rollout at McKay-Dee last fall.
“We had a positive response to going electronic here,” he says. “Part of it was just the inefficiency of how we did things before, where physicians were already spending 60% of their day on documenting. We started working with our vendor in 2013 to set things up. The team was very proactive, and we spent more than a year on staff training. There’s always a steep learning curve, but it has gone better here than other places.”
Poor rollout and lack of physician involvement in system design can be major contributors to EHR burnout, he adds.
“But for hospitalists, going forward, this is the kind of thing where our specialty could really shine—creating specialized roles for ourselves as agents of change,” Dr. Bunnell says. “If we as physicians don’t recognize the drivers behind these mandates, we’ll just continue to react to them. My hope is that … we will embrace the change, get involved, and find ways to use these tools to fulfill their promise.” TH