Physician Burnout Addressed: How One Medical Group is (Virtually) Progressing

Physician burnout continues to be a significant issue in healthcare and healthcare IT circles, and across the country, numerous patient care organizations are taking important steps to address the challenge.

Leaders at one such institution, the Massachusetts General Physicians Organization (MPGO), a multi-specialty medical group that is part of Partners HealthCare in Boston, recently decided to survey their nearly 3,000 physicians and other staff to gain insights into the causes of their burnout. What came from that internal research were a few key observations:

• 46 percent of respondents indicated some form of burnout, via the Maslach Burnout Inventory model or other similar validated scales
• When asked about what was specifically burning them out, the first thing that repeatedly came up was the administrative burden of taking care of their patients
• When asked to drill down on those administrative burdens, the top responses were: working in the ambulatory EHR (electronic health records); dealing with prior authorizations; handling medication reconciliation and associated procedures such as medication renewals; and finally, charge capture, and the associated coding and billing.
• What MPGO leaders learned were that the top responses for burnout almost all come back to working in the EHR, specifically around documentation

“Physicians understand that you have to do e-prescribing, and you have to put problems on the problem list, but the aggregate of putting it all together has meant that they feel they are no longer putting hands on the patients,” says David Ting, M.D., chief medical information officer (CMIO) at MPGO. “It’s not about the doctor-patient relationship; it’s about the doctor-computer relationship, and that’s bumming them out,” he says.

Indeed, EHRs are consistently cited as a top burnout factor for physicians, largely due to the time one must spend in them documenting and performing other administrative tasks. To this point,  a commonly referenced study published in the Annals of Internal Medicine in 2016 found that for every hour physicians provide direct clinical face time to patients, nearly two additional hours are spent on EHR and desk work within the clinic day.

What MPGO physicians wanted Ting and others to investigate, he recalls, was the opportunity to delegate some EHR work to a third-party, or other technology, that would remove the physicians from constantly having “hands on the keyboard and hands on the mouse.”

Fortunately, the organization already had experience working with IKS Health, a global company that provides a virtual scribe service, among other offerings aimed at reducing burnout. Three years ago, MGPO approached IKS for assistance in migrating data from its legacy EHR to the new system, and its executives were so pleased with the results that they went back to the company for its scribe service, called Scribble, which pairs the physician in the exam room with a virtual physician partner (VPP) from IKS.

According to Ting, the big difference between what IKS does in virtual scribing versus the live scribes that are seen across the U.S. today, and other virtual scribe offerings, is that the traditional scribe service uses either recent college graduates who are pre-med or pre-nursing students, or they use transcriptionists. But, Ting notes, IKS uses a pool of physicians that are clinically trained and are conversant with clinical documentation and workflows. “So, the documentation that we get coming out of the virtual scribe is a synthesis of the audio captured in the exam room, rather than a transcript,” he explains. “It’s a real distinction,” he adds.

Ting has heard from his clinicians at MPGO that the EHR “promotes bloated documentation that’s almost unreadable for most clinicians. Medication lists are redundant and there is lots of copy-and-paste from old notes. There’s data that just makes it difficult to read the note,” he says, adding that even when voice dictation software is used, this same problem occurs.

“With the Scribble program, you’re getting concise, synthesized notes. Scribes are listening for the clinical assessment and plan, and since they are doctors themselves, they know what to listen for. We can capture a typical E&M (evaluation and management coding) Level 4 interaction that is completely billing compliant and reflects what’s going on in the exam room, but get it down to a two-page note,” he attests.

At its core, using virtual scribes allows the physician to focus on doing the right thing in the exam room: “call out the exam as I am doing it, vocalize the history, and speak out my assessment and plan. And when they do that, the patients love it,” says Ting. Oftentimes, he notes, physicians work in their own mind and patients are left wondering what he or she is thinking. “But when they verbalize [the information], the scribe captures it all,” says Ting.

IKS currently has 400 physicians on staff in Mumbai, India, giving support to thousands of patient visits a day in clinics across the U.S., according to recent feature on doctors and IT in The New Yorker, written by Dr. Atul Gawande.

Ting, who in addition to being CMIO at MPGO, is also a primary care physician himself, notes that even when he had his physicians using voice recognition software for capturing the conversation with the patient, there was still the issue of writing the note itself after a full day of seeing patients. But with Scribble, says Ting, a physician could see upwards of 15 patients per day “without breaking a sweat, and when I’m done, I’m done—there is no note waiting at home for me.”

So far at MPGO, the virtual service has mostly been rolled out in primary care settings, though it’s making its way into the specialties as well. Ting says that there has been universal feedback from the physicians who are using Scribble that it has saved them significant amounts of time. What are they doing with that time? About one-quarter of doctors say they are seeing more patients and more new patients, Ting reports.

“So, I am a happier person, I can go home and see my kids and I am not wondering how I’m going to write this note up after the patient leaves. Because I’m confident the scribe will capture all of it,” Ting says.