Physician Burnout: The 20 X 20 Explanation for Non-Clinicians

 , September 13, 2016

Neil Mehta, MBBS, MS

Web Editor, JGIM

Physician workload and burnout has been in the news a lot recently.  2 recent studies attempted to better understand and quantify this problem.

A time and motion study of 57 physicians in ambulatory care in 4 specialties and 4 states showed that ⅔ of their office time is spent on EHRs and administrative tasks and they spend an additional 1-2 hours after work on EHR tasks. (Sinsky et al, Annals Int Med, Sept 2016, http://annals.org/article.aspx?articleid=2546704)

A survey of internists nationwide found very high levels of stress and burnout with the major causes being heavy workloads and documentation requirements encroaching into personal time after hours and on weekends and limiting time for exercise and family. (Linzer et al, JGIM Sept 2016 http://link.springer.com/article/10.1007%2Fs11606-016-3720-4.  See infographic below)

Clinicians in all specialties know this already but how do we explain this to a non-clinician?  How do make a case for improving this situation to a lawmaker, a policy maker or an administrator?  While discussing this study with a non-clinician colleague, I used a metaphor that resonated with her so well that I was motivated to post this.

So what did I tell her?  I asked her to imagine having a day where she had 20 back to back meetings, most for about 15-20 minutes, where she had to review a lot of content to prepare for the meeting, where the person she was meeting was anxious, upset, unwell or unhappy, she had to create an agenda for each meeting, arrive at shared decisions, take steps to implement those decisions, and then write the minutes for each meeting.  If she did not finish all those tasks the same day, she would fall further behind the next day as there was not additional time to catch up.  

This is the 20 X 20 day (20 meetings X 20 minutes each or 25X15 for some) that clinicians live throughout their careers.  Do we need more studies to convince anyone wy there is a physician burnout problem?