Work overload is the first driver of burnout, as defined by Maslach and Leiter in their landmark book, The Truth about Burnout. It’s also what most people think about as the most important, if not only, cause of burnout. When there is too much work to do, people become exhausted, the first manifestation of burnout.
Over the past 15 years, the amount of time physicians spend working has increased despite a reduction in per physician patient encounters. There are a few reasons for this:
- Patients are older, sicker, and more complex
- The number of quality metrics we are expected to address to close care gaps have increased
- And of course, with the introduction of the EHR, the data entry burden on physicians has added a significant amount of time per encounter.
One ob-gyn physician sent me a message after my blog post last week in which I reviewed all the drivers, and talked about how he planned to survive until retirement. After spending much of his career trying to fix broken patient care processes, he has given up trying to make difference in the system, focusing on caring for his patients. He also changed to working Locum Tenens positions where there are no expectations that he participate in redesign work.
He is still suffering work overload, reporting that his team of three ob-gyn physicians are seeing the workload of five doctors. In response, I suggested that perhaps what constitutes a workload needing five physicians today would be the same as what three physicians could handle pre-EHR. I was naïve. His list of patients for that day exceeded four pages, not by his choice, but because that is how many the non-physician administrator assigned to each of the physicians.
So while work overload is clearly a component of his burnout, the next driver, lack of control, is significant as well. But that’s the topic for next week.
Work overload leads directly to significant work-life imbalance, as the work load cannot be completed during the workday. Physicians finishing up their EHR work at night has been labeled “pajama time”, and has an impact not only on the physician, but on the physician’s family members. And people are breaking.
We can reduce work overload by assigning a reasonable schedule, redesigning workflows to remove unnecessary frustrations and steps that keep us from focusing on our patients, and offloading data entry and other tasks to team members who are quite capable of doing them. Talk to your support staff. They likely already have some great ideas that can help.
This week, I’d like to know:
- What experiences do you have with work overload?
- What do you think is causing workloads to increase?
- Do you have any workable solutions?
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