Cecilia Lee, Staff Illustrator

Physician turnover is responsible for serious disruptions in health care systems for both physicians and patients receiving care, according to a new study by Yale researchers.

The study draws a correlation between electronic health record use and physician turnover, which is defined as the rate at which current medical professionals decide to leave their jobs or change career paths and no longer practice medicine. Edward Melnick, associate professor of emergency medicine at Yale, led the study in order to devise strategies that could counteract physician burnout and reduce turnover due to electronic health record, or EHR, use. In recent years, EHRs have furthered a push for a holistic profile of patients’ medical histories in order to allow patient care to be more effective, efficient and comprehensive. These records are thorough and must be kept up to date in order to administer quality care at every patient’s visit to the doctor. 

But according to the study, due to the popularization of EHRs, doctors have become more and more dissatisfied with the amount of time spent managing these records and inboxes, leading to higher rates of physician turnover. 

When physician turnover occurs, not only do patients lose their continuity and quality of care, but physicians themselves are affected financially and mentally. Replacement can cost each healthcare facility up to $1 million per physician departure, adding up to over $4.6 billion nationally. Burnout and turnover are expected to trigger a shortfall of more than 35,000 physicians by 2025. 

“I think that the power of EHR use data suggests we will be able to eventually better identify individuals at risk or in crisis so that they can be better supported,” Melnick wrote in an email to the News.

In the study, which was published in JAMA Network, Melnick and his team analyzed two years of EHR use data from a large ambulatory practice network in New England with over 114 practice sites in New York, Connecticut and Rhode Island. This network was selected due to the absence of physicians in training and their lack of teaching responsibilities. 

In their analyses, the researchers found that physician departure was chiefly related to physician productivity and EHR use. Specifically, they found that in instances of lowered rates of other team members responding to physicians’ orders, the risk of physician departure was high. In other words, burnout is related to fewer contributions from team members and higher responsibilities on physicians themselves. 

However, when analyzing time spent working on and managing EHR inboxes, the team found that having physicians spend less time on these tasks was also associated with higher rates of turnover. The study pointed to variables such as physician efficiency and a lower volume of patients, which the researchers said led to the same result.

According to the researchers, these study’s results emphasize the nuanced relationship between physician burnout and EHR usage, and how it can vary across practices.

“The information flow through the electronic record is designed, in many cases, with simply too many touches from the physician or other clinician,” Robert McLean, regional medical director of Northeast medical group of YNHH, wrote in an email to the News. “The large electronic health record companies did not seem to have enough practicing clinician input on some of the basic elements of their design, and that remains a problem to this day.

This shows that another key factor that may lead to physician burnout is the design and layout of the EHR systems themselves. 

The EHR system’s design could explain why physician burnout is likely in instances where there is low contribution from healthcare team members in managing EHRs. 

“In many practices almost every bit of communication (lab and test results, communications from other physicians, patient messages, etc.) go directly to the physician’s inbox,” Allen Hsiao, professor of emergency medicine and pediatrics at the School of Medicine and chief medical information officer at Yale New Haven Health, or YNHH, explained in an email to the News.

Furthermore, McLean reported that due to both the COVID-19 pandemic and the May 2021 CURES Act, the burden of EHR on physicians has recently increased. An important facet of the EHR system is the digital communication between patient and physician that can allow remote access to health care and advice. Although this remote access to physicians through EHR portals has benefitted patients, the rising influx of messages for physicians to manage can lead to burnout when the system itself does not function with them in mind. 

Meanwhile, the federal CURES Act has specified that eight kinds of clinical notes, such as visit notes and all tests, be available for patients to view digitally as soon as they are completed. The effects of this act are nuanced, according to McLean.

“While one can see a clear beneficial aspect to this, one can easily see the tremendous increase in communication traffic and EHR burden that this has led to,” McLean wrote. 

One of the biggest potential benefits of the study is preventing the departure of doctors at high risk of burnout by analyzing EHR use patterns for physicians and their entire care teams. 

Since his team’s findings reinforced that physicians who share EHR responsibilities with other members of the care team experience less burnout, Melnick believes that interventions can be applied in these situations to further reduce the burden placed on physicians.

“Distributing non-medical tasks such as scheduling, refills, referrals, and prior authorizations [could] empower other members of the care team,” Melnick wrote.

In response to the finding that less time spent on EHR management correlated with higher physician turnover, Melnick suggested that physicians who are preparing to depart due to burnout may complete more EHR tasks during their clinical hours or have less EHR-related work. According to Melnick, this could lead to a false sense of reduction in EHR usage, regardless of the physician’s efficiency with EHRs.

Furthermore, Melnick and his team are involved in an ongoing analysis of the study’s findings, hoping to identify risk-benefit analyses that could account for the nuanced circumstances across practices.

Large networks like the Northeast Medical Group have already attempted to account for physicians at risk of burnout.

“There is a great effort already in place … to offload the burdens from the actual practicing clinicians,” McLean stated. “We have come a long way, but there is still a long way to go.” 

The study, published on Oct. 12, can be found here.