Electronic Medical Records, Overworking Drive Burnout

A new study is debunking the notion the prevalence of burnout is not as prominent of an issue in rheumatology as it is in other specialties.

Presented at the 2019 American College of Rheumatology annual meeting in Atlanta, GA, results found more 50% of rheumatologists surveyed reported some form of burnout and more than a third reported being unhappy with their electronic medical record.

In an effort to more accurately depict the current state of burnout among rheumatologists, investigators performed a survey of rheumatologists at the Rheumatology Winter Clinical Symposium in Hawaii in February 2019. Using the Maslach Burnout Inventory, a 22-item questionnaire that includes three domains, emotional exhaustion, depersonalization, and reduced personal accomplishment, investigators received responses from 128 attendees at the conference.

Upon analyses, 51% of respondents demonstrated burnout in at least one domain. Among respondents, 37.5% respondents reported emotional exhaustion, 30.5% reported depersonalization burnout, and 21% reduced personal accomplishment burnout. Further analysis revealed 20% of respondents had burnout in 1 domain, 22.7% had it in 2, and 76.8% had burnout in all 3 domains.

When examining potential contributors to burnout, burnout was among the leading causes—with 34.6% of respondents reported not being happy with their electronic medical record. Analyses indicated clinicians who were unhappy with their electronic medical record were at a 2.86-fold increased risk of experiencing burnout (OR=2.86 P=0.015, 95% CI: 1.23-6.65).

Lack of physical activity and excessive work hours were also major contributors to burnout among rheumatologists. Compared to rheumatologists who exercise at least once per week, rheumatologists who did not exercise were at a 5-fold increase of burnout (OR=5.00 P=0.016, 95% CI:1.3—18.5). Rheumatologists working more than 60 hours a week were at a 2.6-fold increase risk of burnout compared to those working less than 60 hours (OR=2.6 P=0.019, 95% CI:1.16-5.6).

MD Magazine® sat down with lead investigator Martin Bergman, MD, clinical associate professor of Medicine at Drexel University, for more on the study results.

MD Mag: What were the results of your study into burnout among rheumatologists?

Bergman: So, we did study looking at burnout. It was an interesting concept—in that I was asked to give a lecture at a major rheumatology conference last February on burnout—and so, researching it, I found the prevalence of the general population of doctors to be somewhere in the low 50%. So, I figured I had an opportunity to query a captive audience, if you will, highly enriched for rheumatologists. So, we licensed the MBI—the Maslach Burnout Inventory—which is the standardized tool that's pretty much recognized as the tool for measuring burnout.

So we licensed it, we gave it to all the participants who were willing to do that at the conference. I have to be honest with you, when we first were talking about it, we thought "Well, this is a conference, it was in a nice place, people will be relaxed," and there's always this idea that what rheumatology is a little bit of a lower stress field. We're always listed among the happiest of Internal Medicine as rheumatologists. I was thinking "We're going to be maybe enriching in the wrong direction, we may have a low number," and when I calculate scores, I was actually shocked.

It turns out among all the participants, we were at 50.8% were significantly burned out in that they hit one of the three different fields of burnout—8% hit all three. When we'd look just at the physician group, there is about 5-6% of patient people there who were nurse practitioners or other—when we looked at just the physicians, it was 54% had burnout in at least one of the measures, which was shocking. I mean, I was horrified. I mean, it's hard to know what the right adjective, but it was certainly not what I expected and was very concerning.

What we also did is we gave a demographic sheet so you could answer how old you are, what kind of practice you were in, how many years you've been in practice, how much do you make.

A number of different questions to see if there was influence of other factors and the first thing we found out was roughly a third of practitioners do not like their EMR. And if you don't like your EMR, you're 2.8 times more likely to be burned out, which—again—has real implications down the line, which we can get to.

If you don't exercise—if you have zero exercise compared to any even exercising just once a week—you're 5 times more likely to be burned out. People who were in group practices actually turned out to be better and I was a little curious about that, because I was concerned that maybe we would have a problem where you have different personalities and groups, and it might influence it but it turns out it didn't.

Then we looked at somebody who had been looked at before, which was people who spend more than 20% of their time doing something that they find personally satisfying in work—it's not outside of work, but in work—they're 70% less likely to be burned out.

So, these were all fascinating numbers and, for me, there's real implications here, because a lot of times the EMR is being dictated by outside sources. So, a hospital administrator will say, "This is the EMR we're using," without consulting the physicians. Well, if physicians don't like that EMR, there's a good chance you're going to lose those positions over time. They're going to burn out, they're going to leave, they're going to stop practicing, or they're going to be less productive, they're going to have errors. So, this has real implications.

Also, if you overwork them—if they don't take time, if they work more than 60 hours—they also have a roughly 3-fold increase in burning out. So, if you don't give them vacations, you don't let them exercise, you don't give them time off, you have them use an EMR they don't like, or you restrict them to doing things in their practice that you want, not what they want, they will burn out. If they burn out, they don't work for you, they leave, you have to train new people, they make errors, their patient satisfaction is low, so your patient satisfaction when you do your Press Ganey scores will be low. There are real implications here.