Physician Burnout Survey Prepared for November 2018
Introduction Detailed results 2 3 4 Magnitude of Physician Satisfaction and Burnout Mini-Z and Scores Key Drivers Analysis Executive summary Appendix 2
Introduction Clinician well-being, satisfaction and prevention of burnout has become a top priority for the Wisconsin Medical Society. This study on professional satisfaction and burnout is a collaboration between the American Medical Association (AMA) and Wisconsin Medical Society to evaluate joy in practice and improve physician and patient satisfaction. 3
Methodology Online survey Methodology Sampled via Wisconsin actively practicing physicians for which the Society has contact information. Questions are drawn partly from the Physician Work life survey* * Authored by Dr. Mark Linzer, MD - Hennepin County Medical Center, Minneapolis MN Respondents 1165 clinicians completed the survey. 27% response rate. Timing Timing Fieldwork: November 20, 2017 to January 6, 2018 Analysis This report compares the Society results to a national benchmark study that was conducted among a representative sample of 1000 doctors in February 2016. 4
Key Questions Topic Question Answer options Topic Question Answer options 1. Satisfied with current job Overall, I am satisfied with my current job 5 = Agree strongly 4 = Agree 3 = Neither agree nor disagree 2 = Disagree 1 = Strongly disagree 6. Little time spent on EMR at home The amount of time I spend on the electronic medical record (EMR) at home is: 5 = Minimal/none 4 = Modest 3 = Satisfactory 2 = Moderately high 1 = Excessive 2 No symptoms of burnout Using your own definition of burnout, please choose one of the numbers below: 5 = I enjoy my work. I have no symptoms of burnout. 4 = 3 = I am beginning to burn out and have one or more symptoms of burnout 2 = 1 = I feel completely burned out. I am at the point where I may need to seek help. 7. Good documentation time Sufficiency of time for documentation is: 5 = Optimal 4 = Good 3 = Satisfactory 2 = Marginal 1 = Poor 3 Aligned with clinical leaders My professional values are well aligned with those of my clinical leaders: 5 = Agree strongly 4 = Agree 3 = Neither agree nor disagree 2 = Disagree 1 = Strongly disagree 8. Calmer work atmosphere Which number best describes the atmosphere in your primary work area? 5 = Calm 4 3 = Busy, but reasonable 2 1 = Hectic, chaotic 4 Care team works efficiently together The degree to which my care team works efficiently together is: 5 = Optimal 4 = Good 3 = Satisfactory 2 = Marginal 1 = Poor 9. Workload Control My control over my workload is: 5 = Optimal 4 = Good 3 = Satisfactory 2 = Marginal 1 = Poor 5 Not stressed because of job I feel a great deal of stress because of my job 5 = Strongly disagree 4 = Disagree 3 = Neither agree nor disagree 2 = Agree 1 = Agree strongly 10. No Frustration with EMR * The EMR adds to the frustration of my day: 5 = Strongly disagree 4 = Disagree 3 = Neither agree nor disagree 2 = Agree 1 = Agree strongly * No Frustration with EMR is part of Mini-Z v2 questions, but not asked in the national benchmark study 5
Definitions and Targets Measure and Definition Calculation Success Criteria 1. Joyful Workplace (Mini-Z Scores) Sum of questions 1-10 Range = 10-45** a joyful workplace 80%* Burnout 80% Joyful workplace 2 Supportive work environment ( 1 ) Sum of questions 1-4. Range = 4-20 a highly supportive practice 16 16 Highly supportive practice 3 Work pace and no EMR stress ( 2) Sum of questions 5-8. Range = 4-20 an office with good pace and manageable EMR stress 16 16 Good pace & manageable EMR stress 4 Work pace and no EMR stress + No Frustration with EMR * ( 3) Sum of questions 5-8,10. Range = 5-25 an office with good pace and manageable EMR stress 20 20 Good pace & manageable EMR stress * Mini-Z target is 40 out of 50 (80%). However, for the national benchmark study, the target is 36 out of 45 (80%). Because Q10 was not asked. Therefore, percentages are used to compare the two. 6
Introduction 1 2 Magnitude of Physician Satisfaction and Burnout Detailed results 3 4 Mini-Z and Scores Key Drivers Analysis Executive summary Appendix 7
Executive Summary Satisfaction levels among surveyed clinicians are the lowest of any clinical group studied to date. Fewer than two-thirds of clinicians surveyed say they are satisfied with their current job, while 20% are dissatisfied. Satisfied = 64% Neutral = 16% Not Satisfied = 20% No Burnout = 13% Under Stress = 33% Burnout = 54% Over half of surveyed clinicians describe themselves as burned out or having symptoms of burnout. Burnout level is relatively high upon comparison to 29% among clinicians in the general population. Mini-Z scores indicate that survey response numbers are below the desired target for zero burnout. Burnout 60.6% Joyful workplace 8
Executive Summary Among surveyed clinicians, there are some differences in rates of burnout by subgroups, related to years of experience, age, practice settings, documentation method and practice type. Lower burnout experienced among: 1-5 Years of Experience Higher burnout experienced among: 11-20 Years of Experience 31-40 and 51+ Year Olds 41-50 Year Olds Non-Surgical Specialty Primary Care Specialty Team Documentation / Scribe Dictation to Transcription / I Type My Notes Hospital Multi-Specialty Group Practice 9
Executive Summary Surveyed clinicians are extraordinarily frustrated by EHR demands and regulatory requirements leading many to seriously consider leaving the professional altogether. Clinicians express significant anger over current systemic practices which they feel undervalues their knowledge and training. Top Stressors EHR documentation takes too long Difficulties with EHR IT systems Charting / documentation takes too long Insurance policy / requirements / restrictions Patient satisfaction surveys Management doesn t pay attention to physician concerns Poor compensation Would like more support staff Poorly set / unrealistic administrative goals Required to use EHR to meet billing goals Government policy / requirements / restrictions Suggestions from Clinicians: Leave medicine altogether / retire early Assistance with documentation: scribes, administrative support staff should take responsibility Reduce total workload and work time, and increase quality of time with patients Management needs to pay more attention to physician concerns / feedback Provide adequate staffing levels and compensation Increase AMA advocacy 10
Introduction Detailed results 1 2 Magnitude of Physician Satisfaction and Burnout 3 Mini-Z and Scores Key Drivers Analysis 4 Executive summary Appendix 11
Satisfaction With Current Job At 64%, the satisfaction level among surveyed clinicians is the lowest of all burnout studies conducted to date. Approximately two-thirds of surveyed clinicians are satisfied with their current job, with 20% dissatisfied, well below the benchmark satisfaction rate of 80%. Satisfaction with current job Satisfied with Current Job = 64% Mean = 3.60 Society 5% 15% 16% 44% 20% Benchmark Satisfaction = 80% Mean = 3.91 NATIONAL BENCHMARK 2% 7% 12% 57% 23% Overall, I am satisfied with my current job (5) AGREE STRONGLY (4) (3) (2) (1) STRONGLY DISAGREE Base: Total Sample = National Benchmark (N=1000); Society (N=1165) 12
Burnout Level Surveyed clinicians experience significantly higher burnout levels than the 29% recorded in the national benchmark study. Only 13% of surveyed clinicians say they have no symptoms of burnout. Burnout Level Burnout = 54% Mean = 3.38 Society 4% 13% 37% 33% 13% 29% Mean = 3.81 NATIONAL BENCHMARK 1% 6% 22% 53% 18% Using your own definition of burnout, please select which of the following statements best describes you: (5) I enjoy my work. I have no symptoms of burnout. (4) (3) I am definitely burning out and have one or more symptoms of burnout. (2) (1) I feel completely burned out. I am at the point where I may need to seek help Base: Total Sample = National Benchmark (N=1000); Society (N=1165) 13
Mini-Z Scores Summary The survey scores do not attain the target for Joyful Workplace. While survey results score better than the national benchmark on work pace and manageable stress, they fall short for highly supportive practice Mini-Z Score - Society Highly Supportive Practice ( 1) Good Pace & Manageable Stress ( 2 ) Good Pace & Manageable Stress ( 3 ) (60.6%) 30.3 14.0 11.2 13.5 Burnout 10 50 Joyful workplace 10 20 Highly supportive practice 10 20 Good pace & manageable stress Good pace & manageable stress 10 25 NATIONAL BENCHMARK = 63% JOY TARGET 80% NATIONAL BENCHMARK = 14.7 TARGET 16 NATIONAL BENCHMARK = 10.8 TARGET 16 NATIONAL BENCHMARK = NA TARGET 20 * Target is 40 /50 (80%) and 36 /45 (80%) for the national benchmark, because Q10 was not asked. Therefore, percentages are used to compare 14
Survey scores fall short of the joy target on all metrics Survey scores succeed against the national benchmark on efficient care team, not stressed, calmer work atmosphere, but fall short on satisfaction and burnout due to issues relating to clinical leader alignment, EMR/documentation time and workload control Mini-Z Score and Contributing Factors Society National Benchmark Joy Target Mini-Z Score - Society 1 2 3 4 5 (60.6%) Satisfied with current job 3.6 3.9 30.3 No symptoms of burnout 3.4 3.8 Aligned with clinical leaders 3.4 3.5 Care team works efficiently together 3.7 3.5 Not stressed because of job 2.7 2.3 Less time spent on EMR at home 3.2 3.4 Good documentation time 2.4 2.5 Calmer work atmosphere 2.9 2.7 Workload Control 2.8 3.0 No Frustration with EMR 2.3 Burnout 10 50 Joyful workplace NATIONAL BENCHMARK = 63% JOY TARGET 80%* * Target is 40 /50 (80%) and 36 /45 (80%) for the national benchmark, because Q10 was not asked. Therefore, percentages are used to compare 15
Survey scores fail to achieve the joy target for highly supportive practice Care team efficiency is better than national benchmark study, but still short of the 'Joy Target. Highly Supportive Practice ( 1) Society National Benchmark Joy Target 14.0 4 20 NATIONAL BENCHMARK = 14.7 TARGET 16 Highly supportive practice Satisfied with current job No symptoms of burnout Aligned with clinical leaders Care team works efficiently together 1 2 3 4 5 3.6 3.9 3.4 3.8 3.4 3.5 3.7 3.5 16
Survey scores underperform the Joy Target on metrics related to work pace and manageable EMR stress Survey scores outperform the national benchmark for not stressed and calmer work atmosphere, but lags the national benchmark in all other areas. Good Pace and Manageable EMR Stress ( 3) Society National Benchmark Joy Target 13.5 1 2 3 4 5 Not stressed because of job 2.7 2.3 5 25 Good pace & manageable EMR stress Less time spent on EMR at home Good documentation time 2.4 2.5 3.2 3.4 NATIONAL BENCHMARK = NA TARGET 25 Calmer work atmosphere No Frustration with EMR 2.3 2.9 2.7 17
Surveyed clinicians experience varied sources of stress Surveyed clinicians experience widespread frustration over the requirements to utilize EHR and administrative goals which require these tools. Physicians express EHR reduces their job to a cog in a machine, undervalues their education and training and requires them to emphasize profits over patients. Physicians express a great deal of anger over the regulatory and administrative framework, requiring them to spend more time on busy work than on treating patients. Many physicians strongly dislike having compensation tied to patient satisfaction surveys and patient compliance. Leaving the professional altogether is a common response expressed to these challenges. I wish our organization, which is supposedly a non-profit Christian organization, would either practice our mission of provided the best quality care for our patients or just admit that we don't a hoot about patients, providers, or caregivers and are slaves only to the almighty dollar. Can physicians start running healthcare again? Why are business majors making all the decisions about healthcare now? This is not a business, it's people's lives and health we are dealing with. People who know healthcare and care what happens to patients should make decisions. Epic EMR is very poor, a "fat", not a "lean" system that has substantially lowered productivity and needlessly increases complexity, to no benefit of the patient. It was implemented due to Obamacare financial incentives, not because it was proven to be a good system in practices like ours. I'd say this is the single worst thing to have happened in the field of medicine since I've been license to practice these 40 years. I can't wait till retirement!!!! This is not what I envisioned practice of medicine to be. Oftentimes, I feel that I have been reduced to a glorified clerk!!! Ton of paperwork that you can't be reimbursed. Medicine cannot be totally financially driven by health care systems over-riding physicians EMR dictating 4 hours every night, insurance companies trying everything to not pay me and wasting my time and staff, primary care not taking responsibility for their patients, government with demands with reporting that have little to do with care of the patient etc etc. complete spiral downward deterioration of healthcare Q2.11: Tell us more about your stresses and what we can do to minimize them. 18
Top 3 concerns: Documentation time, EHR Issues and insurance / government regulations Number of Scheduling / Time Issues Mentions EHR documentation takes too long 91 Charts / documentation takes too long 44 More time with patients / issues can't be addressed in 15 minutes 22 Work hours are too long 21 Not enough scheduling flexibility / flexibility for personal time 10 Needing to do prep work, such as patient phone calls, before / after shift 7 Not enough downtime / time to relax 3 Commute time is too long 2 EHR / IT Issues Difficulties with EHRs 84 Need to use EHR to satisfy billing goals 23 Would like different documentation methods (e.g. dictation, scribes, etc.) 22 Needing to take care of EHR documentation before / after shift 21 General IT issues (e.g. printing difficulty, login problems, etc.) 8 Would like EMR Consultation / training 1 Insurance / Regulatory / Policy Stresses Insurance policy / requirements / restrictions 35 Government policy / requirements / restrictions 23 Hospital policy / requirements / restrictions 10 Malpractice claims 3 Difficulties with Insurance Company communications 2 Communication Issues Eliminate / disregard patient satisfaction surveys 30 Difficulties with patient / family communication 5 Internal team member communications 5 19 Q2.11: Tell us more about your stresses and what we can do to minimize them. Number of Mentions Support / Management Issues (Net) Management / administration too remote / doesn't listen to physicians 29 Not enough administrative support / would like more support staff 27 Poorly set / unrealistic administrative goals 25 Lack of independence / ability to make own decisions 20 Too many levels of administration 13 Not enough peer staff / would like more peer staff 12 Feeling unrecognized / unrewarded 12 Lack of Nursing support 12 Poor department leadership 11 Being treated poorly / not respected by team members 10 Management / administration prioritizes profits over patients 9 Little or no peer support 5 Quality of Work Environment Issues (Net) Poor compensation 28 Poor work / life balance 9 Would like a gym / exercise / focus on health & wellness 3 Not enough opportunities for / recognition of / support for research 2 Would like quiet work areas / quiet uninterrupted time 1 Poor patient / provider facilities / logistics 1 Workload Issues (Net) Eliminate overnight call / On call 19 Total Workload: Patient visits, phone calls, patient management 19 Too many patients 18 Difficult to treat patients / complex 5 Billing / costs management (Net) Poor / decreasing reimbursement 12 Additional Stresses (Net) Leave medicine 25 Increase AMA advocacy / AMA should do more 15 Board certification process 9 Prefer single payer system 9
Introduction Detailed results 1 2 3 4 Magnitude of Physician Satisfaction and Burnout Mini-Z and Scores Key Drivers Analysis Executive summary Appendix 20
Mini-Z and Scores - By Years of Experience Since Residency Surveyed clinicians experience lower burnout rates at shorter tenure lengths and at 20+ years in practice. Higher Mini-Z Score = Less burnout NATIONAL BENCHMARK YEARS OF EXPERIENCE SINCE RESIDENCY Mini-Z Base Ratings 1 2 TOTAL 1000 28.4 14.7 10.8 1-5 YEARS E 113 28.7 14.8f 10.9 6-10 YEARS F 174 28.1 14.2 10.9 11-15 YEARS G 201 28.0 14.3 10.9 16-20 YEARS H 166 28.4 14.6 10.8 MORE THAN 20 YEARS J 346 28.8fG 15.0fG 10.7 WISCONSIN MEDICAL SOCIETY YEARS OF EXPERIENCE SINCE RESIDENCY Base Mini-Z Ratings 1 2 3 TOTAL 1165 30.3 14.0 11.2 13.5 1-5 YEARS J 124 6-10 YEARS K 129 31.5 IJ 30.5 J 14.2 j 11.7 IJ 14.2 IJ 14.0 11.1 13.7 11-15 YEARS L 127 29.0 13.6 10.6 12.8 16-20 YEARS M 177 28.9 13.5 10.6 12.8 MORE THAN 20 YEARS N 537 30.9 IJ 14.3 ij 11.5 IJ 13.8 IJ How many years have you been in practice since completing residency? Letters indicates row is significantly higher than the labelled row. Upper case is 95% confidence and lower case is 90% confidence. ABOVE Target [ Targets : Mini-Z Score = 40 1 and 2 = 16 3 = 20] 21
Mini-Z and Scores - By Physician Demographics Nationally, clinicians aged 51+ experience less burnout than others. A similar pattern is seen among WMS clinicians with those aged 41-50 experiencing the most burnout of all age groups. Higher Mini-Z Score = Less burnout NATIONAL BENCHMARK DEMOGRAPHICS Base Mini-Z Ratings 1 2 TOTAL 1000 28.4 14.7 10.8 31-40 B 230 28.6 C 14.6 10.9 41-50 C 325 27.9 14.3 10.7 51-64 D 358 28.6 C 14.9 C 10.7 65+ E 83 29.7 BCD 15.5 BDd 11.0 MALE N 635 28.3 14.6 10.7 FEMALE P 346 28.8 14.9 10.9 WISCONSIN MEDICAL SOCIETY DEMOGRAPHICS Base Mini-Z Ratings 1 2 3 TOTAL 1165 30.3 14.0 11.2 13.5 31-40 B 182 31.3 C 14.2 C 11.6 C 14.2 CD 41-50 C 273 28.9 13.5 10.6 12.8 51-64 D 474 30.2 C 14.0 c 11.2 C 13.4 C 33.7 15.3 13.0 15.4 65+ E 129 BCD BCD BCD BCD MALE K 685 30.8 14.3 I 11.5 L 13.7 FEMALE L 376 30.0 13.9 10.9 13.3 What is your Age? / Are you? (Male/Female) Letters indicates row is significantly higher than the labelled row. Upper case is 95% confidence and lower case is 90% confidence. ABOVE Target [ Targets : Mini-Z Score = 40 1 and 2 = 16 3 = 20] 22
Mini-Z and Scores - By Practice Setting And Specialty Surveyed clinicians in non-surgeon specialties experience significantly lower levels of burnout. Higher Mini-Z Score = Less burnout NATIONAL BENCHMARK PRACTICE SETTING Base Mini-Z Ratings 1 2 TOTAL 1000 28.4 14.7 10.8 IN-PATIENT A 111 28.4 14.6 11.0 OUTPATIENT B 603 28.6c 14.8c 10.8 BOTH INPATIENT AND OUTPATIENT C 278 28.1 14.4 10.8 SPECIALTY TYPE NON-SURGEONS A 392 28.5 14.7 10.8 PRIMARY CARE B 355 28.3 14.6 10.7 SURGEONS C 253 28.6 14.7 10.9 PRACTICE SETTING WISCONSIN MEDICAL SOCIETY Base Mini-Z Ratings 1 2 3 TOTAL 1165 30.3 14.0 11.2 13.5 IN-PATIENT C 148 30.8 13.9 11.7 de 14.2 De OUTPATIENT D 619 30.2 14.0 11.1 13.3 BOTH INPATIENT AND OUTPATIENT E 280 30.1 14.0 11.1 13.4 SPECIALTY TYPE NON-SURGEONS W 473 31.1 U 14.4 U 11.6 U 14.0 Uv PRIMARY CARE U 435 29.8 13.7 11.0 13.2 SURGEONS V 109 30.0 14.1 11.1 13.2 In what type of setting do you spend the majority of your clinical time? Letters indicates row is significantly higher than the labelled row. Upper case is 95% confidence and lower case is 90% confidence. ABOVE Target [ Targets : Mini-Z Score = 40 1 and 2 = 16 3 = 20] 23
Mini-Z and Scores - By Documentation Method WMS physicians who utilize Team Documentation / Scribes or Dictation to Voice Recognition experience significantly less burnout. Higher Mini-Z Score = Less burnout NATIONAL BENCHMARK DOCUMENTATION METHOD Base Mini-Z Ratings 1 2 TOTAL 1000 28.4 14.7 10.8 TEAM DOCUMENTATION/SCRIBE C 72 28.9 c 15.1 c 10.7 E DICTATION TO TRANSCRIPTION D 100 28.2 14.5 10.7 E DICTATION TO VOICE RECOGNITION E 133 27.8 14.5 10.7 E I TYPE MY NOTES AND/OR USE TEMPLATES F 650 28.5 14.6 10.9 ce OTHER G 45 28.8 15.7B CD 9.7 WISCONSIN MEDICAL SOCIETY DOCUMENTATION METHOD Base Mini-Z Ratings 1 2 3 TOTAL 1165 30.3 14.0 11.2 13.5 TEAM DOCUMENTATION/SCRIBE DICTATION TO TRANSCRIPTION DICTATION TO VOICE RECOGNITION I TYPE MY NOTES AND/OR USE TEMPLATES C 50 33.1 DeF 15.4 DEF 12.2 DF 14.7 Df D 176 29.2 13.6 10.8 12.9 E 272 30.9 D 14.4 DF 11.5 d 13.7 d F 575 30.1 13.8 11.1 13.5 OTHER G 32 32.3 D 14.6 12.3 Df 14.6 D In which of the following ways do you document clinical information in your practice? Letters indicates row is significantly higher than the labelled row. Upper case is 95% confidence and lower case is 90% confidence. ABOVE Target [ Targets : Mini-Z Score = 40 1 and 2 = 16 3 = 20] 24
Mini-Z and Scores - By Role and Practice Type Physicians, MD/DO and DOs experience similar burnout levels. Also, burnout levels are lower for hospital-based physicians. ROLES WISCONSIN MEDICAL SOCIETY Base Mini-Z Ratings 1 2 3 TOTAL 1165 30.3 14.0 11.2 13.5 Physician (MD/DO) A 1018 30.4 14.1 11.3 13.6 Physician (DO) B 85 29.4 13.7 11.1 13.3 Higher Mini-Z Score = Less burnout WISCONSIN MEDICAL SOCIETY PRACTICE TYPE Base Mini-Z Ratings 1 2 3 TOTAL 1165 30.3 14.0 11.2 13.5 PHYSICIAN'S OFFICE M 174 30.5 13.9 11.3 13.4 MULTI-SPECIALTY GROUP PRACTICE N 429 29.6 13.8 10.8 13.0 HOSPITAL O 398 30.8 N 14.2 n 11.5 N 13.9 N SKILLED NURSING FACILITY P 4 32.3 13.6 13.0 15.5 HOSPICE Q 2 40.0 19.0 15.0 17.5 URGENT CARE FACILITY R 21 32.7 14.3 13.5 16.0 OTHERS T 73 31.7 N 14.7 N 12.0 N 14.3 N Which of the following best describes you? Which of the following best describes your main practice? Letters indicates row is significantly higher than the labelled row. Upper case is 95% confidence and lower case is 90% confidence. ABOVE Target [ Targets : Mini-Z Score = 40 1 and 2 = 16 3 = 20] 25
Respondent Profile Society Age NATIONAL BENCHMARK Gender Society Years of Practice (Since Residency) NATIONAL BENCHMARK 1% 16% 23% 41% Average Age 52 11% 8% 21-30 31-40 41-50 51-64 65+ No answer Male, 59% Gen Pop= 64% Gen Pop= 35% Female, 32% 9% Prefer not to answer '1-5 years '6-10 years '11-15 years '16-20 years More than 20 years Not Answer 11% 11% 11% 15% 6% Average 17.5 Years (Gen Pop=15) 46% How many years have you been in practice since completing residency? *Note: See appendix for definitions Base: Total Sample = 1165 26
Respondent Profile Practice Setting Outpatient In-patient 13% Both inpatient and outpatient 23% Others 5% Not Answer 5% 53% Society NATIONAL BENCHMARK Primary Documentation Method I type my notes / use templates 49% Dictation to transcription Dictation to voice recognition Team documentation/scribe Other Not Answer 15% 23% 4% 4% 5% Society NATIONAL BENCHMARK In what type of setting do you spend the majority of your clinical time? You mentioned you document clinical information in the following ways. Please indicate which is your primary method of documenting clinical information. Please select only one response. Practice Type Physician's office, solo practice Physician's office, single specialty Multi-specialty group practice or clinic Hospital, teaching Hospital, non-teaching Urgent care facility Other Not Answer 3% 2% 7% 5% 12% 18% 16% 37% Which of the following best describes your main practice? Average Number of Clinicians in practice (Gen Pop=16) 12 Base: Total Sample = 1165 27
Respondent Profile Role Medical Specialty (Physicians)* Physician (MD/DO) 87% 37% Society NATIONAL BENCHMARK 41% Physician (DO) 7% 9% 13% Not Answer 5% Primary Care Surgery Specialists Non-Surgery Specialists No Response How many years have you been in practice since completing residency? *Note: See appendix for definitions Time Spend on EHR Outside Work 0-2 hours 2-4 hours 4-6 hours 6-8 hours More than 8 hours No Weekly 2% 20% 18% 13% 17% 29% Time Spent on Direct Patient Care 0 hours 1-10 hours 11-20 hours 21-30 hours 31-40 hours 41-50 hours No Activity 2% 0 hours 8% 1-10 hours 19% 11-20 hours 24% 21-30 hours 29% 31-40 hours 13% 41-50 hours 4% No Activity Time Spent on Indirect Patient Care 2% 10% 4% 2% 5% 40% 36% Time Spent on Admin 0 hours 1-10 hours 11-20 hours 21-30 hours 31-40 hours 41-50 hours No Activity 7% 12% 2% 1% 1% 6% Time Spent on Research / Teaching 0 hours 71% 1-10 hours 11-20 hours 21-30 hours 31-40 hours 41-50 hours No Activity 8% 3% 1% 1% 11% 36% 41% Mean: 4.2 hours Mean: 27.1 hours Mean: 13.4 hours Mean: 7.4 hours Mean: 5.4 hours Base: Total Sample = 1165 28
Future Attitudes Decrease Hours / Retire Expected Age of Retirement Yes 45% Society Mean Age to Retire: 64.7 No Not Sure 18% 32% 3% 5% 17% 30% 27% 8% 5% 5% No Answer 5% Below age 50 Age 50-55 Age 56-60 Age 61-65 Age 66-70 Age 71-75 Age 76-80 No Answer Q5.1 In the next 5 years, will you decrease your clinical hours or retire entirely from clinical work? Q5.2 At what age do you plan to retire from medicine? Change in Retirement Plans Yes No Not Sure No Answer 5% Q5.3 Have your retirement plans changed due to the health care environment? Base: Total Sample = 1165 Note: Asked among Society sample only 15% 36% 45% Recommend Career as Physician Yes 39% No Not Sure 29% 27% No Answer 5% Q5.4 Would you recommend a career as a physician to a prospective student? 29
Determinants of Physician Burnout - Using Regression Analysis Regression analysis* indicates that beyond overall stress and job satisfaction, physician burnout is mostly determined by: Atmosphere Teamwork EMR / documentation time / frustration Satisfaction, atmosphere and EMR time are more important drivers than the national benchmark. Work stress, workload control, age, years since residency and professional values are much less important than nationally. % change in burnout Chart explained Title by each factor NATIONAL BENCHMARK Job Satisfaction Stress at Work Control over workload Age Years since residency Time with Documentation Team Work Work Atmosphere EMR Frustration / proficiency Professional Values Time Spend with EMR Number of physicians (FTEs) 1.1% 1.6% 1.4% 5.1% 2.1% 0.4% 5.5% 6.4% 5.3% 8.7% Society 26.2% 34.6% Net of documentation and EMR = 8.3% * Multivariate regression at a 95% confidence level was conducted to determine the causal effect of other questions to the burnout question. Adjusted R Square = 49.8% 30
Determinants of Physician Satisfaction - Using Regression Analysis The top determinants of physician satisfaction for surveyed clinicians are: Alignment of professional values with those of clinical leaders. Efficient team work Control over workload Stress at work In the national benchmark, the top determinants of satisfaction are 1) alignment of professional values; 2) efficient team work; and 3) sufficiency of time for documentation * Multivariate regression at a 95% confidence level was conducted to determine the causal effect of other questions to the burnout question. ** Note: Burnout question is excluded from the regression % change in satisfaction explained by each factor NATIONAL BENCHMARK Professional Values Team Work EMR Frustration / proficiency Time with Documentation Control over workload Stress at Work Years since residency Work Atmosphere Age Number of physicians (FTEs) Time Spend with EMR 1.7% 0.5% 0.7% 2.3% 2.5% 1.1% 0.1% 6.8% 10.8% 11.7% Society 30.5% Adjusted R Square = 54.8% 31
Open End (Verbatim) Comments The attached file contains verbatim comments offered by surveyed clinicians on their sources of stress. It is recommended to read these comments as they provide context to the ratings. Double click the Microsoft Excel icon to read verbatim comments Comments can be filtered by: Respondents Mini-Z score (Benchmark= 40+) 1 and 2 (Benchmark = 16+) Overall satisfaction - Scale of Not Satisfied) to 5(Completely Satisfied) Burnout ratings - Scale of 1(Burnout) to 5(No Burnout) 32
Key Takeaways Wisconsin Medical Society Surveyed satisfaction levels fall below all other groups studied. 64% of surveyed clinicians say they are satisfied with their current job, and over half of these clinicians described themselves as burned out or having symptoms of burnout. Mini-Z scores confirm that satisfaction and burnout levels are below targets for zero burnout. Burnout is experienced more by: 11-20 years of experience No Burnout = 13% 60.6% 41-50 year olds Clinicians specializing in primary care Under Stress = 33% Burnout Joyful workplace Dictation to Transcription / I Type My Notes Burnout = 54% Multi-Specialty Group Practice Beyond feelings of stress and job satisfaction, physician burnout is mostly determined by: Distressed work environment Inefficient team work EMR time / frustration Physicians experience job-related stress from a variety of sources, particularly lack of support for workloads: Burdensome documentation requirements Systemic difficulties with using EHRs Burdensome and arbitrary insurance and governmental policy requirements / restrictions A perceived lack of respect for physician skill and knowledge from management Prioritization of profits over patient care 33