Incentivizing doctors based on patient outcomes rather than volume alleviates many causes of burnout
Although reports of physician burnout multiplied during the COVID-19 pandemic, it has always been a problem in health care. According to a study from the Mayo Clinic, the COVID-19 pandemic only exacerbated existing problems in the health care delivery system and took a toll on the U.S. physician workforce. This added strain impacted the quality of care, resulting in turnover and reductions in work effort. The Association of American Medical Colleges also estimates that the U.S. could see a shortage of 54,100 to 139,000 physicians by 2023 which is expected to plague both primary and specialty fields.
Physician burnout remains a critical issue across all aspects of health care because it affects the quality of care, cost efficiency and accessibility to care. Burnout among providers can lead to poor interactions with patients and patient dissatisfaction, while also contributing to impaired attention, memory and executive function.
These conditions can result in lower quality scores and worse clinical outcomes. For physicians themselves, burnout might incline them to rushing through patient visits or even leaving medicine entirely. In fact, 2021 saw the largest-ever exodus of physicians in the United States, with an estimated 333,942 healthcare providers leaving their jobs, according to Definitive Healthcare. These labor shortages can reduce care accessibility and even result in facility closures, removing access to care for communities with already limited resources like rural communities.
While labor shortages exacerbate burnout, it’s important to acknowledge that the issue isn’t driven purely by employment and demand. Frustrations with administrative processes, lack of autonomy and control and other challenges can combine to foster feelings of burnout. Fortunately, this means there are various ways to address factors contributing to burnout. Implementing mental wellbeing practices in the workplace, encouraging work-life balance and streamlining processes through technology are all ways to begin alleviating these issues. Another avenue to allay physician burnout is embracing value-based care.
Value-based care is a health care delivery model through which providers are incentivized based on the health outcomes of their patients and the quality of services rendered. Essentially, providers are paid based on the quality of care provided, rather than the quantity of patients they see. The transition from fee-for-service or volume-driven health care to value-based care is a clear path to helping alleviate the conditions that create physician burnout.
With other care delivery models, providers are incentivized to treat as many patients as possible, impacting their ability to engage patients and provide appropriate care. Value-based care puts more emphasis on coordination and prevention, which better aligns with the values of most primary care physicians.
Compared to fee-for-service care, value-based care allows providers to be more intentional about the care they provide for their patients. They can be more attentive during appointments, better manage their time and build trust with patients, while not having to worry about meeting a quota of patients to ensure payment. This can enhance the quality of care and lessen the workload providers must manage, helping alleviate burnout.
On average, up to 25% of a physician’s time is spent on administrative duties. This detracts from their ability to deal with critical matters that involve patient care and can foster feelings of discontent. Centralizing care management through accountable care organizations (ACOs) as part of value-based care models helps standardize processes and programs, which can streamline administrative tasks and allow physicians to focus on patient care.
Studies have shown that effective ACOs can reduce readmissions, spending and hospitalizations. Through internal data sharing and increased technical capabilities, primary care providers participating in an ACO often gain access to new data that provide them with much more information on patterns of care, utilization and costs associated with their patients. ACOs can be especially helpful for independent physicians because they receive the benefits of larger organizations while retaining their autonomy.
While value-based care addresses many of the causes of physician burnout, there are also other, more immediate methods of reducing burnout. For example, there are technologies available for providers and medical personnel to tackle administrative tasks such as managing patient check-ins, keeping electronic medical records and portals for patients to use to make appointments and gather additional information.
Implementing telehealth and virtual visits can also save time for providers and patients, especially for regular check-ups or visits that don’t require many examinations. These technologies can be implemented independently or as part of a transition to value-based care to streamline processes and alleviate workloads, allowing providers to continue focusing on the quality of care they provide to their patients.
Value-based care can seem overwhelming, particularly for those already experiencing burnout, but partners and resources are available to support the transition. Fee-for-service’s transactional approach to care places a higher value on volume, which isn’t always best for patients or providers. By implementing value-based care models, providers can focus on providing high-quality of care for their patients rather than the burden of maintaining a volume of visits, thus helping to alleviate stress and burnout.
Ultimately, value-based care can help the health care industry and those involved be more intentional, with a focus on prevention and outcomes, allowing them to fully embrace their passion for improving the lives of their patients.
Dr. Steele is chief medical officer, Collaborative Health Systems