Is The EMR The Cause Of Physician Burnout?

 

Is The EMR The Cause Of Physician Burnout?

Physician burnout is a problem we need to take more seriously. Burnout can lead to work dissatisfaction, depression, and even suicide. Without a doubt, it is harmful to us as physicians, as well as our patients and the community as a whole. Could the EMR be the root cause of physician burnout?

When asked why physicians feel so burned out, a common culprit is the electronic medical record (EMR). For a long time, I never understood why.

Before the EMR, there were paper charts. Remember those things? So much patient health information in those huge three ring binders. Back in 2007, I was begrudgingly tasked to fetch all the patient charts for rounds as a lowly third year medical student on clinical rotations. Those binders were heavy. Especially when your list went 15 sick patients deep! Lugging those charts around was one thing. Reading notes was another. Half the time I couldn’t decipher the scribble of a consultant’s plan.

An electronic record should be so much better, right?

Then why is the EMR often cited as a major contributor to physician burnout?

 

What is Burnout?

In order to understand burnout and its various causes, we should define it first.

The World Health Organization defines burnout as a syndrome linked to long-term, unresolved, work-related stress.

The key components that characterize burnout include:

• Physical and emotional exhaustion
• Cynicism, detachment, and depersonalization
• Feelings of ineffectiveness and lack of personal accomplishment

Physicians have a high rate of burnout. In a recent Medscape Report, about 44% physicians reported feeling burned out.

That’s alarmingly high.

 

EMR and Physician Burnout

When you think about it, the EMR directly contributes to all three components of burnout.

Physical and emotional exhaustion

Sitting down in front of the computer all day is not natural. It can be extremely exhausting. Our bodies are not designed to be sedentary. We are meant to move.

In addition, staring at a screen for extended periods of time can cause some serious eye strain. Every click of the mouse is one step closer to hand arthritis and joint pain.

With the perceived increased efficiency of the EMR, physicians are expected to see even more patients. It’s not uncommon for physicians to see at least 30 patients a day, leaving only 10-15 minutes of time spent with each patient.

Physicians already spend a lot of time at work. But when so little time given for each patient, physicians often have to stay later to catch up on charting, paperwork, and other bureaucratic tasks. This further contributes to the physical exhaustion. Not only that, it is mentally overwhelming and emotionally exhausting.

Cynicism, detachment, depersonalization

It’s not hard to see why the EMR would cause depersonalization. The EMR is an electronic interface that literally comes between face-to-face patient encounters. Many physicians feel that the increased computerization of practice interferes with and erodes the doctor-patient relationship.

The widespread implementation of EMR was hastened by the Health Information Technology for Economic and Clinical Health Act (HITECH Act) in 2009. In effect, this act incentivized all hospitals and hospital systems to adopt an EMR. Along with this new law came a number of new government regulations and decreased reimbursements. As a result, physicians are now tasked with more administrative burdens including coding, billing, and regulatory compliance. This leaves less time for meaningful patient care and a sense of detachment from being an actual physician.

Many physicians feel reduced to being technicians, working merely to check all the boxes of patient care protocols. The trifecta of the EMR, evidence-based medicine, and government regulations leads to the standardization of medical practice. It’s easy to see why many physicians feel a reduced sense of autonomy. Feeling like just another cog in a wheel is a common sentiment. Fulfilling maintenance of certification requirements also feels like “checking the boxes”. All of this leads to a sense of cynicism.

Feelings of ineffectiveness and lack of personal accomplishment

The direct correlation between the EMR and feelings of ineffectiveness isn’t obvious at first. But after reading this article by Dr. Robert Pearl it is more evident. In summary, his article relates how a major cause of burnout is the EMR and how its collection of physician comparative data can lead to physicians feeling a sense of ineffectiveness at work.

Comparing yourself to other physicians can potentially lead to a perceived lack of respect from your colleagues. Comparison often leads to unhappiness.

The EMR also allows hospitals greater ability to focus on the numbers, shifting the emphasis to profits over patients. This is one of the reasons why patients don’t feel valued anymore. Low patient satisfaction scores lead to physicians feeling a lack of respect from patients.

Performance data is often tied to compensation. Failing to meet metrics in clinical performance and patient satisfaction scores often lead to reduced pay and insufficient compensation. Let’s face it. Our self worth and feelings of accomplishment are often tied to compensation. Many physicians don’t feel valued anymore.

 

So is the EMR the Cause of Physician Burnout?

Not necessarily.

The EMR is certainly a contributor to physician burnout. But it may not necessarily be the root cause.

In the Medscape report, physicians were asked the question “What Contributes to Physician’s Burnout?”

The results are below.

The EMR impacts all of these factors. I’ve highlighted in bold all of these contributing factors in the previous paragraphs above.

 

Final Thoughts

The widespread implementation of the EMR started in 2009, the same time I started residency. I can’t believe it’s been 10 years already!

During this time, the rate of physician burnout is only increasing. It is clear that the EMR is a contributing factor.

The EMR is supposed to make the practice of medicine more efficient. It’s supposed to make the delivery of patient care better. But does it?

Perhaps the way we use the EMR could be changed. Just like other modern technologies (think: social media), we should use the EMR as a tool to bring more value to patient care. Instead, the opposite seems true.

The EMR is devaluing physicians, patients, and the physician-patient relationship. In turn, this causes the compassion fatigue and moral injury that is at the very heart of physician burnout.

This needs to change!

 

What do you think causes physician burnout? Do you think the EMR is a major contributor? What would you change about the system to reduce burnout?