US physicians are overloaded and burned out. They now work an average upwards of 11 hours per day. Over 60% exhibit burnout symptoms, over 20% want to leave the profession, and one in ten has contemplated suicide.†
A recent survey of over 20,000 physicians identified pervasive burnout drivers and aggravating factors: crushing workload, time pressures and related stress; electronic health record (EHR) software use; inefficient teamwork; chaotic work environment; poor work control; and not feeling valued.
These are all symptoms of a much deeper problem: clinical productivity waste.
Clinical productivity waste (CPW) is the squandering of physician time and talent. It is what drives physician burnout — and it now consumes most of their workday. On average, ~62% of physicians’ time is wasted.
The cost of CPW to healthcare providers is substantial. The often-cited figure for physician burnout cost is $4.6B annually. However, its primary root cause — CPW — actually costs the healthcare industry $372B/yr.
The math is straightforward: The total direct expense of physicians in the healthcare industry is just over $600B/yr. The mean % of physician time lost to CPW is 62%, times $600B is $372B.
Breaking Down CPW
There are four primary ways in which physician time is wasted, contributing to burnout and accruing in CPW:
|Primary drivers of CPW||% of time wasted|
|1. Physician time wasted on EHR||~ 18-38%|
|2. Poor skills-task alignment (inefficient teamwork)||~10-20%|
|3. Unproductive and inappropriate care (chaotic)||~7-11%|
|4. Collaboration overhead and interruption (poor work control)||~8-12%|
Here are some examples of each:
- Wasted EHR time. Electronic Health Record (EHR) software is designed primarily for administrative use, as opposed to clinical utility. But it has become the de facto core of healthcare IT. Result: For every hour of time seeing patients, physicians spend around two hours of EHR time, much of it wasted. Consider performing a simple chart review, which accounts for 33% of the ~18-38% physician time wasted in the EHR: going into the patient’s records, digging up those relevant to your specialty or immediate needs, then synthesizing what’s going on in the case. For example, in a cancer case, the physician might want pertinent information, such as the location and grade of the tumor, the risk stratification, the results from the most recent CT, where the patient is in the treatment plan, and so on. But this information is spread over numerous records in the EHR, that not only must be searched for and found in the system, but also must be read and parsed, then extracted and synthesized in order for the physician to fully understand the case.
- Poor skills-task alignment. Given current staffing and training issues in healthcare, physicians are often performing tasks that other lesser-skilled staff could or should be doing on their own. For example, with a nurse in cardiology caring for a patient with suspected heart failure, there’s a protocol to follow. But with a shortage of cardiology NPs, the nurse on duty may need to ask the physician “what’s next” at each step. Before making any decisions, the physician is going to have to understand where the nurse is in the protocol (and if the protocol has been followed), as well as what the status and updated situation is – and that’s time wasted relative to physicians are working “at the top of their license.”
- Unproductive or inappropriate care. There are numerous examples where physician time is spent needlessly. For example, a referral of a patient to a specialist often comes with a long fax of records on the case. The specialist wades through the fax to make sense of the case only to find that the referral is premature or even that they’re not the right specialist (say it’s spine surgeon and the patient hasn’t undergone prerequisite physical therapy yet).
- Collaboration overhead and interruption. Collaboration is essential in healthcare, but interruptions and task-switching can waste substantive amounts of time and incur increased cognitive burden. In the cardiology example above, each time the nurse contacts the physician about what to do next, the physician needs to spend time to refresh their memory on the case, answer the question, and then afterwards to refocus on what they were originally doing. That may only take 2-3 minutes per interruption, but the wasted time adds up quickly.
The amounts of time wasted in each of these examples will vary by physician and situation. One physician may always be required to wrestle information from the EHR, while another can “staff it out” for planned appointments. Another will waste more time dealing with unproductive diagnostics, and another covering gaps in support staff skills or training. Importantly, CPW derives from all these drivers. EHR inefficiency, while it’s the most widely discussed physician productivity drain, still accounts for less than half of total CPW.
The Financial Case for CPW Cost Recovery
US physician burnout constitutes a healthcare crises, and the AAMC now projects that the current shortage of ~40,000 physicians may grow to a shortage of as many as 110,000 physicians by 2030. Unsurprisingly, according to a survey of healthcare CEOs, staffing was their number one challenge in 2022, followed by financial challenges and safety/quality concerns — all impacted by CPW.
To say nothing of the urgent need to improve physician professional satisfaction, CPW is the most egregious deficiency in healthcare function and represents a staggering opportunity for cost recovery. In a mid-sized hospital with 575 acute care beds and 1,100 physicians on staff, the annual cost savings of eliminating 15% of CPW would be $55.4M.
Saving even a quarter of physicians’ wasted productivity (and 15% of their total time) would cut industry costs by over $90B. Said another way, 15% of wasted productivity was eliminated, and all the savings were allocated to cost, it would improve a provider’s operating income by an absolute 2% (-.5% operating income becomes +1.5% operating income). That’s substantial when you consider that average hospital operating margins fell from -0.7% in December 2022 to -1% in January 2023, with over 600 rural hospitals in danger of closure.
Cutting CPW is a “force multiplier” – it combats physician burnout, which in turn improves patient safety and care quality, while substantially improving financial results.
For restoring the health of the US healthcare industry, that’s a trifecta.
† For the full list of references underlying the figures in this post, please contact the author.