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Never in the history of medicine have we experienced such a high degree of clinician burnout and turnover. Physician turnover takes a heavy toll on patients and the lives of physicians and their families. The cost of replacing physicians through the process of recruitment, lost revenue, onboarding, and time to return to optimal efficiency can be upwards of $1million per physician departure. This can be problematic for many hospitals and health care organizations that are experiencing high rates of physician burnout or turnover that has only been exacerbated by the ongoing pandemic and impending threat of another COVID-19 surge.
Previous survey research has established associations of electronic health record (EHR) use with professional burnout and reduction in professional effort, but these findings are subject to response fatigue and bias. In collaboration with Yale University, MedStar Health investigators Raj Ratwani, PhD, Daniel Marchalik, MD, MA, Mihriye Mete, PhD, and Allan Fong, MS evaluated the association with physician productivity and EHR use patterns with physician turnover as detailed in the recent study “Analysis of Electronic Health Record Use and Clinical Productivity and Their Association with Physician Turnover” published in JAMA Network Open.
This retrospective research study included 314 non-trainee physicians who worked exclusively in an ambulatory care delivery network without teaching duties. EHR use and scheduling data were collected using the Epic Signal platform and Epic Clarity database, respectively. EHR user actions were tracked via mouse action or keyboard action using a 5-second latency period where the user is idle for 5 seconds and tracking pauses until user actions resume. Physician demographic data, including termination status and departure date were also recorded.
The associations between departure status, physician productivity, and EHR use patterns were examined monthly for each physician. Physician productivity was based on demand, patient volume, completed appointments/month, and intensity. EHR use was determined by analyzing total EHR time, note documentation, work outside of scheduled clinical hours, time on inbox, and teamwork. Physician specialties were grouped into 3 categories: primary care, medical specialties, and surgical specialties.
Overall, the study found:
- Physician productivity and EHR use metrics were associated with their departure, while physician age, gender and specialty were not.
- Counterintuitively, less time spent on the EHR was associated with physician departure and warrants further investigation.
- The specialties with the highest turnover rates were medical subspecialities, surgical specialties, gastroenterology, and internal medicine.
- A teamwork approach may help to prevent physician turnover. This finding is consistent with evidence that team-based care can reduce professional burnout and optimize team performance. This suggests that a prospective model of vendor-derived EHR data could help to identify physicians at high risk of departure who might benefit from targeted team-based care interventions.
The research team suggests that standardizing vendor-derived EHR data definitions in a way that is clinically relevant and qualitative exit interviews to provide further insight into existing data and the association between EHR use, burnout, and physician attrition, could be beneficial. With greater data validity and reliability, future models could prospectively identify physicians at high risk of departure who would benefit from targeted interventions to improve retention. Future studies could also further assess the association of burnout and departure with EHR use by linking survey data with EHR use and productivity metrics with more detailed information on departure. Additional future research could prospectively track physician productivity and EHR use patterns to identify physicians at risk of departure.
As the COVID-19 pandemic continues to keep us diligently searching for solutions while also responding to clinical and administrative duties, MedStar Health is committed to providing resources and tools to help prevent burnout for both physicians and our administrative staff. This research and the broader work from our team of investigators is just one avenue we are exploring to find ways to create more balance among our clinicians. Learn more about MedStar Health wellness initiatives here.