Looking at the after-hours work, I think a lot of it is because EHRs require people to document more.

Most of us put off administrative tasks in order to get the work done during the day. But since documentation for billing, insurance companies, and individual practice mandates has to be completed before the following day, it really does force what becomes a longer work day. And a lot of physicians don't necessarily perceive the fatigue that comes with the chronic nature of this until it gets to a point where they're overworked, overstressed, and potentially burned out.

I think primary care feels it the most because their reimbursement levels are lower, so they have a harder time adding team members to help out with this work. There are very few surgeons today who practice without midlevels to do a lot of this work for them.

Adding scribes and midlevel providers – physician assistants, nurse practitioners – has had the biggest impact at PeaceHealth.

With scribes, the documentation is really being managed by someone other than the physician, both in the exam room and after. And midlevels, particularly in hospital settings, are able to handle the notes, the orders, and most of the EHR. The work gets done through the course of the day, and physicians just have to review the work before they go home.

Adding this extra layer of providers to the team does cost money, but I think it's the thing that relieves the burden on physicians most dramatically.

I know a group of physicians that added scribes and midlevels to its practice, with nurse practitioners doing a lot of the admitting of patients to the hospital and other related documentation. Suddenly, the physicians were able to see two or three more patients per day and still get out at the same time with all their work done.

So they were able to add this extra layer, cover their costs by seeing more patients, and improve the lives of their physicians.

We have heard our staff's desire to make more personal connections with their colleagues. Recently we had a Saturday boat party down at the bay with food trucks and music. We saw people who you wouldn't expect to see together, people who are otherwise in competition, people in different practices or specialties, all gathering in groups chatting about life, making connections. We have repeated this type of gathering in a variety of settings with similar successes.

Our Wellness Committee has a process for physicians to reach out when they may be struggling personally or professionally. We have a regular stream of self-referrals or partners calling up the committee and saying, “Hey, so-and-so is struggling right now. They've had a death in the family, or something else is going on." Then we can proactively reach out, stay in touch, offer resources and support. Even with hospital staffs of 500 to 1,000 people, it's important to keep in touch with individual lives.

We've actually developed a local LLC for wellness, The Physicians Wellness Alliance (PWA), specifically to address the problems for physicians needing help with burnout or other behavioral health issues.

One challenge is, how do you find a professional to see who is interested in dealing with physician issues, and burnout, specifically? And then, how do we provide access to that kind of expert, particularly in a smaller community?

The PWA developed a teletherapy service, KavuMD, with a panel of individual psychologists who focus on the issues physicians face.

KavuMD is built to give control to the physicians. It is a self-referral program and is not used in disciplinary cases. Because of the stigma and perceived threat to a physician's license, their identity remains anonymous. Only the psychologists know their name; neither PWA nor their employers know who has sought help.

We are trying to reduce the barriers for a physician to seek help. It's so much more convenient to get online and do a telehealth visit. The last thing a physician needs is another time commitment. With teletherapy there is no commute, and they can pick a private place and convenient time to connect with a therapist.

Regardless of the issue, KavuMD provides an opportunity for a physician to talk with a professional that understands what they are going through. It's not a solution to burnout, but another tool in the complex battle to help physicians in the current healthcare environment.

I know there is no one solution for burnout, but at PeaceHealth we are trying to build a culture where we listen to physicians about issues affecting the group as a whole, but also those affecting the individual.