No easy answers to physician burnout -AND- California Hopes $3 Billion Experiment Will Improve Health Of Neediest

CAL/AAEM News Service at
Wed Jan 11 13:20:39 PST 2017



December 22, 2016


No easy answers to physician burnout 



VHK2R2ZmNkTUtveERzSEdBNDluRnVMdjZcL0Q5ZWkzIn0%3D> Fierce Healthcare



By Aine Cryts


Some 900,000 practicing physicians, along with millions of other healthcare
workers, are caught in a complicated healthcare web that leads to an
epidemic of burnout in the medical field.


"We believe that to alleviate the stress and burnout in the medical
professions, we must pay attention to system factors that lead to what we
call the 'occupational health crisis in medicine,'" write two doctors in an
opinion piece on STAT. Steven A. Adelman, M.D., director of Physician Health
Services Inc., a nonprofit corporation founded by the Massachusetts Medical
Society, and Harris A. Berman, M.D., dean of Tufts University School of
Medicine, recently surveyed 425 physicians, healthcare leaders and
executives about eight possible ways to transform healthcare.


Top on that list was an overhaul of the cumbersome, time-consuming
electronic health record (EHR) systems that impact the well-being of doctors
and the vitality of medical practice, they write.


Physician burnout is typically recognized as emotional, physical and mental
exhaustion brought on by prolonged stress. It's a problem in dire need of a
solution, as an estimated 350 to 400 doctors kill themselves each year.


EHR has contributed to widespread doc burnout


The problem of physician burnout has certainly been magnified by the EHR and
goes directly to the fact doctors cannot spend the time they want with
patients, according to a NEJM Catalyst article.


Michael Schneck, M.D., a professor at Loyola University Chicago Stritch
School of Medicine, told the publication that changes are needed to create a
better experience for physicians and patients. "We take people who are
highly trained, highly educated individuals selected because of their
motivations in terms of humanism and their ability to learn copious amounts
of material, and we turn them into highly educated factory workers," Schneck
told NEJM Catalyst. "We ask them: 'How many patients have you seen?' 'How
many procedures have you done?' 'How have you met quality metrics?'"


Physician burnout is only getting worse. Fifty-four percent of physicians
reported at least one symptom of burnout in a 2015 study-and that was up
from 45.5% in 2011. Physicians' happiness in terms of work-life balance also
went down, from 48.5% in 2011 to just shy of 41%. Equally troubling, half of
physician respondents said they felt emotionally exhausted and that the work
they do is less meaningful.


Why doctors experience burnout


Change has been the norm in healthcare over the last few years, and doctors
have experienced that change most acutely. To wit, the 2015 study
highlighted that physicians feel like they are part of a "fixing-people
production line."


One reason for physician burnout is the "myth of invulnerability" that
doctors promote. This myth-building typically starts during medical school.


While no specialty is left untouched by burnout, critical care professionals
have some of the highest rates of burnout in the healthcare industry. A
study that captured data spanning the past 10 years revealed that up to 45%
of critical care physicians experience severe burnout; at 71%, this figure
was even higher for those in pediatric critical care.


5 ways to prevent burnout 


Still, healthcare organizations can help alleviate stress and burnout among
physicians by undertaking some of these initiatives:


Encourage doctors to embrace outside interests. For example, Paul Parker,
M.D., a Georgia pediatric surgeon, plays bluegrass music in a band with
other physicians as a way to reduce stress. He also plays his banjo and
guitar in his office in between surgical cases.


Focus on physician wellness. Children's Healthcare of Atlanta has organized
such a program to support its physicians' physical and mental well-being.
Key elements of the program include communication, physical activity,
learning, nutrition and stress management. Yoga and meditation can also help
with wellness.


Help doctors be more efficient. Make sure your doctors focus on care of
patients-not on administrative tasks. And as Adelman and Berman suggest,
developing a more physician-friendly EHR can help.


Support physicians in saying "no." Encourage your doctors to decline
committee assignments or even patient demands when they already have too
many commitments.


Redesign the practice. One idea is to outsource burdensome tasks such as
compliance and waste management. Alternatively, practice could choose to
bring in a trainer with this type of expertise to educate practice




December 22, 2016


California Hopes $3 Billion Experiment Will Improve Health Of Neediest 



UDJhSUPSxu9UPvfbsbFhY&_hsmi=39685897> Kaiser Health News



By Anna Gorman


Riverside County plans to connect former inmates with health clinics and
social services. Orange County hopes to get homeless residents into housing
- and help them stay there. Placer County is opening a respite center where
homeless patients can go after they leave the hospital.


Those are just some of the pilot projects in a $3 billion experimental
effort officials hope will improve the health of California's most
vulnerable populations. The effort is a recognition that improving people's
health will take more than just getting them insured.


The state has approved plans in 18 counties intended to reduce unnecessary
emergency room visits and hospital stays among these groups. In addition to
ex-prisoners and the homeless, they include people who have multiple chronic
illnesses, substance abuse problems and mental health disorders. The state
is accepting a second round of applications for such projects next year.


The effort, known as "whole person care," is part of an agreement between
California and the federal government. It gives the state flexibility to try
to improve the efficiency and quality of care in the state's Medicaid
program - known as Medi-Cal - which provides health coverage to low-income


The projects are designed to blend physical care, mental health care and
social services for the participants, who are among the neediest and
costliest in the state.


"We have people coming out of jail and they are homeless, they don't have
food and they are diabetic and they are bipolar and they drink too much
alcohol and they use heroin," said Judi Nightingale, director of population
health for Riverside University Health System. "They need services from
different county departments in 20 different locations . and we don't talk
to each other."


Half the funding for the program comes from the federal government, and the
other half will be provided by local entities, including counties and
hospital systems.


Some county leaders fear President-elect Donald Trump's plan to dismantle
the Affordable Care Act could derail their plans, but they hope nothing will
change right away. State officials are urging counties to continue laying
the groundwork for their projects, which are expected to start next spring
or summer.


"We are just moving forward in terms of implementation and not speculating
on any changes that might happen," said Sarah Brooks, a deputy director at
the state Department of Health Care Services. "We will see what comes in the
next year."


Mark Ghaly, a program director with Los Angeles County's Department of
Health Services, said he believes the program is going to stand for at least
a while. "The question is will we have enough time to show what works," he


The key to success will be getting various agencies to work together to
identify participants and serve them no matter where they are, Brooks said.


Part of that depends on being able to share data, which remains a challenge
for many counties, Brooks said. Most counties have multiple electronic
health records systems that may not interact with other government computer
systems. There are also patient privacy concerns.


Riverside County's project aims not only to reduce ER use but also to keep
former inmates out of jail. They will be screened upon their release and
offered help with housing, health insurance, drug treatment and mental
health services.


Los Angeles County's project, which will cost $900 million over five years,
is an ambitious effort to improve the health of high-risk populations,
including the homeless and recent inmates. The county plans to target about
1,000 soon-to-be released inmates each month and will use community health
workers to help them get the care and social services they need. The county
also is working to get inmates released with a 30-day supply of medications.


Ghaly said he believes the project will "stabilize people upon release so
they don't hit the emergency departments in the volume they are now."


Nadereh Pourat, director of research at the UCLA Center for Health Policy
Research, said she expects the projects to improve care and outcomes as well
as save money. "There is going to be some reduction in [emergency
department] use if you are wrapping these additional services around these
populations who are complex and high-need," she said.


More than 14 million Californians are covered by Medi-Cal, including about 5
million who have signed up since the Affordable Care Act took effect in
2014. The health reform law allowed states to expand the number of people
who were eligible. Many new Medi-Cal beneficiaries went years without
coverage and had untreated chronic conditions and mental health and
substance use disorders.


Insurance coverage is the first step because it gets them in the door,
Pourat said. But that must be followed by getting them the right services to
keep them out of the hospital. The pilot programs will allow the state to
see what works and doesn't work, Pourat said. They will be evaluated based
their impact on ER visits, inpatient stays and other measures of health and


"It's a great laboratory," she said. "There is not going to be a cookie
cutter approach throughout the state."


The planned projects vary in size, method and goals. Many include housing
services, care management and data sharing. For the counties that focus on
homeless people, federal money cannot be used to pay rent. But it can be
used for other housing services such as move-in costs, financial education
and outreach to landlords.


In Orange County, officials are linking homeless residents to primary care
providers and helping them find places to live.


"If we are able to get them stabilized and into stable housing . we can
improve their overall health," said Melissa Tober, manager of strategic
projects for the Orange County Health Care Agency.


In Placer County, which also will target homeless residents, Health and
Human Services Director Jeff Brown said each participant will have an
intensive care plan, which may include substance abuse treatment, mental
health care or peer support. Brown said the pilot project provides the money
and flexibility.


But, he said, "There really is no road map for the perfect way to implement
this, and without that road map or blueprint, it can be a bit difficult."




Jeff Wells
Deputy Editor, CAL/AAEM News Service


Brian Potts MD, MBA
Managing Editor, CAL/AAEM News Service

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