Doctors Experiencing Burnout
Even before the pandemic, half of all doctors and nurses said they had considered leaving medicine. The number one cause for doctors and nurses departing is burnout. Although the number of doctors feeling burned out decreased from 2014 to 2020, burnout has returned with a vengeance in the age of Covid-19, which amplified fears of infection and health resource shortages. Doctors from minority or marginalized communities are even more likely to experience the onset of stress and anxiety from difficult working conditions.
Covid aggravated the caregiver shortage, but the fundamental problems at the root of physician dissatisfaction remain: bureaucratic burdens (including EMRs and “heads buried in screens”), lack of respect (from administration/staff/patients), excessive workload, scheduling issues and chronic low pay for nurses and primary doctors.
This is the biggest increase of emotional exhaustion that I’ve ever seen…
Director, Duke University Center for Healthcare Safety and Quality, as quoted in The New York Times, 9/29/2022
Most large hospitals are architectural labyrinths, with departments often separated by floors or even buildings. Better design can improve care coordination, treatment and collegiality, thereby reducing burnout and promoting collaboration. Intentionally designed buildings use space to bring specialists from related areas together.
NURSES WHOSE BREAK ROOMS HAD VIEWS OF THE OUTDOORS
I walk out of my neurosurgery operating room and I’m interacting with a cardiologist. The next turn is a radiologist. The next turn is a vascular surgeon. … We’re able to have coffee and lunch together. … We hang out. We solve problems collaboratively, and this improves staff morale and the medical care of patients.
Adnan H. Siddiqui, MD, PhD
CEO and Chief Medical Officer, Jacobs Institute; Professor and Vice Chairman of Neurosurgery, Jacobs School of Medicine and Biomedical Sciences
A LIGHT AT THE END OF THE TUNNEL
In a recent Texas Tech study, nurses whose break rooms had windows with views of the outdoors reported 18% less stress, 26% less emotional exhaustion and 40% less dehumanization (“feeling like a robot”) compared with those whose break rooms had no windows.
A SUNY Upstate Medical University study showed that simply opening shades in a work area reduced emotional exhaustion by 25% and dehumanization by 33%.
The building that houses the Jacobs School of Medicine and Biomedical Sciences opened in 2017 and features an open six-story light-filled atrium that fosters interaction among physicians, innovation and a strong sense of community.
The choice of location of new healthcare facilities communicates which groups are being served. The Jacobs School of Medicine’s location in downtown Buffalo puts it within walking distance of a traditionally underserved population in the predominantly lower-middle-income Allentown neighborhood.
1/3Of total healthcare costs are administrative
$250 BILLIONPotential annual savings from standardization of systems with AI
In our hospital system we have more than enough data; the key is understanding it and acting upon it. Make it functional and actionable
Director of Periop and Procedural Business Ops, Kaleida Health
Unlike clinical medicine, which is complex and variable, healthcare administration is replete with menial, repetitive tasks ripe for automation. Administration accounts for nearly a third of total healthcare costs ($1.2 trillion of $4.1 trillion), and a recent McKinsey study suggested that standardization of systems powered by AI could save around $250 billion per year. We expect a 20x increase in investment in AI technology for healthcare, with a focus on patient administration. Medical coders, billers and schedulers will see their ranks thin drastically.
IS THERE A ROBOT IN THE HOUSE?
Robots have been used for years in surgery, as well as for pharmacy tasks and the on-site transport of lab samples, food and medication. Robots using ultraviolet light help cleaning teams reduce the number of hospital-acquired infections. Robotic tools have become commonplace in laparoscopic surgery, and we expect use of robots in surgery to quadruple by 2030, but fully autonomous robots in the OR are still years away and face significant hurdles from hospitals and regulators.
AI AND THE MEDICAL CHART
Remarkably, nurses and doctors spend between a quarter and half their working day on documentation. Companies like Augmedix and Nuance listen to providerpatient interactions and use automated speech recognition and natural language processing to generate clinical notes, cutting charting time by 40%. By 2030, automatic documentation technology will chart 70% of patient encounters, alleviating one of the leading causes of provider burnout.
Covid drove a 154% increase in e-visits. Use has fallen since 2020, but not to pre-pandemic levels. Telemedicine will grow steadily in the next ten years as it becomes part of a hybrid care-delivery approach. Though touted as a means of reducing burnout, recent data suggests that telemedicine increases physicians’ after-hours EHR-work burden. As documentation AI improves, telemedicine will finally deliver on its anti-burnout promise. In the next five years, hospitals will adopt natural language processing to generate a structured patient record immediately following each telemedicine encounter.
AUGMENTED REALITY AND VIRTUAL REALITY IN MEDICAL INSTRUCTION
The educational use of augmented reality and virtual reality technologies is accelerating. Studies have demonstrated its effectiveness in improved knowledge gain (anatomy) and technical skill acquisition (surgery and line placement), along with empathy, communication skills and clinical decision-making. In certain cases, AR and VR will supplant real-world experience (e.g., the cadaver lab), but more often will be woven into medical school curricula and resident training. Coupled with more robust artificial intelligence, AR/VR will offer bespoke, dynamic scenarios to meet specific learning goals. Furthermore, researchers are combining 3D AR headset displays with older technologies like ultrasound to improve the accuracy of procedures like needle insertion. This will likely become a core competency for medical students.
-200KDOCTOR SHORTAGE, US
-1.3MNURSE SHORTAGE, US
+17MINCREASE IN HEALTHCARE USERS OVER AGE 65
The worst-case scenario is where we are today, but with 20 million more older people.
CEO, American Academy of Physician Associates
Even with new technology, the supply of caregivers may not be large enough to meet demand. The 65-plus population— which consumes three times more healthcare than younger groups—is on a steep growth curve, from 56 million in 2020 to 73 million by 2030. The educational and training pipeline for healthcare workers is too constricted on the front end, and we are losing too many experienced caregivers to burnout in their prime years.
One major reason is a misaligned education pipeline. In the past 20 years medical schools have increased enrollment by more than half, but there’s been no commensurate increase in residency positions. Changes in government policies and funding will be critical in turning the tide. The vast majority (80%) of residency positions are paid for by Medicare, but Congress has added funding for only 1,000 new positions since 1997, and repeated bills to increase funding have failed. In 2022, there were 39,205 residency positions and 42,549 applicants. If underserved populations begin to use healthcare like higher-income Americans—which we would all like to see—there will be a total deficit of 200,000 doctors in the US in the mid-2030s.
Congress and state governments also have failed to increase funding to train new nurses, while restrictions on immigrants are impacting the supply of foreign-born nurses, who make up about one-sixth of the workforce.
By 2025, the nurse shortage will be as much as 450,000; by 2030 it could be up to 1.3 million. Nurse training programs have for years turned away tens of thousands of qualified applicants due to a lack of faculty and clinical training locations. Physician organizations continue to lobby against the expansion of clinical roles for physician assistants and nurse practitioners in order to preserve higher incomes for doctors.
Nurse practitioners (NPs) are more likely than doctors to practice primary care in underserved areas, particularly rural regions. By 2030, a patient will be twice as likely to see an NP versus a doctor for primary care in a rural setting. In primary care, multiple studies and systematic reviews show that NP and PA patient outcomes are similar or better than care provided by physicians alone; they also lower costs. Already, 26 states and Washington, DC, have passed laws that allow NPs to practice independent of physician supervision. By 2030, more than 40 states will have similar laws, which will help NPs and PAs deliver effective care to more diverse populations, especially those where access to care is a major impediment.
Ninety-nine percent of the reason we can’t get full practice authority passed in all states is because of the physicians.
Chief Officer, Nursing Regulation, National Council of State Boards of Nursing
A recent study published in the American Economic Review highlighted the potential of creating a more ethnically diverse workforce. The study, conducted in Oakland, California, showed that African American men were more likely to agree to preventive services after meeting with an African American doctor. The study authors concluded that increasing the number of black doctors could reduce gaps in black-white mortality by 19%.
CREATING A DIVERSE HEALTHCARE WORKFORCE
A diverse country needs ethnically and socioeconomically diverse doctors. Teaching hospitals play a critical role in our healthcare system by providing exceptional medical care and helping to catalyze medical innovation. The Association of American Medical Colleges (AAMC), a large network consisting of over 150 medical schools, 400 teaching hospitals and nearly 80 academic societies, has created an educational framework to help medical schools increase diversity in healthcare.
The overwhelming majority of medical schools and teaching hospitals have diversity initiatives, and the class of 2021 was the most ethnically and racially diverse yet. Geographic and socioeconomic diversity remains a challenge. Only 5% of medical school matriculants are from rural counties and only 5% come from families in the lowest 20% by income. In the medium term, the focus on ethnic and racial diversity will be matched by geographical and socioeconomic considerations.
As the medical students become more diverse, schools’ curricula are being redesigned to embed racial considerations. In 2022, spurred by students, the Jacobs School of Medicine and Biomedical Sciences at the University at Buffalo introduced a new medical curriculum with antiracism at its core. Rather than relegate the issue to stand-alone courses, the Jacobs School integrates antiracism holistically, highlighting the theme across all educational settings.
Academic medical institutions should be a driver of economic development in underserved communities. Beyond creating career paths for students, they are an engine of economic growth and opportunity by attracting startups, labs and other new businesses. Medical schools can improve the health of citizens and the local economy at the same time.
Allison Brashear, MD, MBA
Vice President for Health Sciences and Dean of the Jacobs School of Medicine and Biomedical Sciences