Tom Castles

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Complexity is a defining characteristic of modern healthcare. Even for the most experienced among us, the American healthcare system often feels like a bottomless well of issues, with each one tied in an inextricable knot to thousands of others.

So what’s the solution? Well, we can’t quite agree on that just yet. But like most problems, many of us know that getting things headed in the right direction will require strong leadership, a unified vision and a willingness to stretch the limits of what we previously thought was possible.

Perhaps that’s why many are looking to Amazon to move the needle in healthcare. The deft business maneuvers of Jeff Bezos, the retail behemoth’s founder and chief executive, have led not only to his recognition as the richest human alive but also one of the world’s foremost leaders, visionaries and innovative thinkers. At least on paper, Bezos and his brainchild Amazon seem to have the characteristics of the savior many in healthcare are betting on to make a difference.

But as precedence has shown, rarely does a single, neat packaged solution like Amazon wipe out a puzzling problem. It’s almost never that simple—especially in healthcare.

On this crossover episode of Data Book, cohosts Jack Murtha and Tom Castles partner with 

 to explore what history can reveal about those who forego the hard work in favor of a silver bullet solution.

Then, we bring on two respected healthcare leaders — CNBC’s 

 — to examine the ways Amazon could mix things up in the near future, for better or worse.

More on Amazon’s potential in healthcare:

Podcast: Amazon Alexa and the Potential for Voice Assistants in Healthcare

Podcast: How Big Tech is Targeting Healthcare

Podcasts

How looking for a savior could help and hurt modern healthcare.
 

Podcast: Amazon's Healthcare Hubris and the Perils of 'Silver Bullet' Thinking

During a time when pain was an accepted consequence of illness, disease and injury, William Stewart Halstead ushered in the era of anesthetics. Almost overnight, pain was avoidable. Simply inject a little cocaine at the site of discomfort and 

At least that’s what Halstead concluded following a series of experiments he conducted on himself. You see, he was pioneering the use of anesthetics during a time when little was known about their volatile power. What’s more, there were no legal ramifications for their possession or use. Without precedence or consequence, he was free to experiment with drugs however he pleased. And as a talented and beloved teacher who is also credited with ushering in the era of hands-on medical training, he offered himself up as a training tool for his students.

Perhaps Halstead was too committed to this novel approach to education. As a result of the experiments he conducted on his own body, he sunk into what would become a lifelong addiction to drugs. It started with cocaine and then swung to morphine. And throughout this grueling addiction, Halstead was working incessantly to lay the groundwork for approaches to surgery and anesthesia that we still use and value today.

He was also busy laying the groundwork for modern medical training — all while high on cocaine. He worked hours that’d be more aptly suited for a machine. His residents were on call 362 days a year. He set a pace that most students – especially those not on a heavy dose of stimulants – would be hard pressed to match.

For all his contributions to medicine, Halstead became known as the father of modern surgery. But his drug-fueled jaunts resulted in an approach to medical education that is probably too much to bear for its students because, as we know too well, they’re burning out.

On this episode of Data Book, we explore the comeuppance of William Stewart Halstead, the strange duality of his contributions to medicine, and explore how we might move past the oppressive cultural institutions he left in his wake.

The Holocaust Survivor Who Forced Us to Face Burnout

Nuance, Tech and Fighting Physician Burnout

Shedding Light on the Culture Behind Physician Burnout

Cocaine-fueled medical education helped set the stage for physician burnout. 

Podcast: How the Father of Modern Surgery Became a Healthcare Antihero

HIMSS is a lot like college. You'll learn a lot at the lectures, but the true lessons emerge serendipitously — often when you least expect them. 

Every session, every handshake, every passing conversation and every hurried step seems to bring with it unforeseen, unexpected, and invaluable insights. So many new connections — both the human and the neurological kind – are packed into the fleeting five-day period that attempting to unpack them takes nearly as much effort as gaining them in the first place.

>>> READ: Making the Most of Your HIMSS Experience

In the end, I hope we all emerge with the sense that it was worth it. There are finite opportunities in life to forge connections that are so personally and professionally beneficial, and HIMSS certainly ranks among the best for those of us who’ve made digital health our life’s work.

On this episode of Data Book, Jack and I look back at some of the serendipitous moments that made HIMSS more than worth it for us, and a few that we could’ve done without. Then, we bring back our dear friend Janae Sharp — a HIMSS veteran, a HIMSS social media ambassador, and one of the strongest, most insightful #WomeninHIT – to offer some 20/20 hindsight perspective on the biggest meeting in digital health – HIMSS 2019.

More insights from the floor at HIMSS ’19:

Setting Expectations Around AI in Healthcare

Healthcare Needs Tech That Empowers Physician Leaders

Survival of the ‘Fitness’ and Electronic Health Records

Powerful insights from the floor at digital health’s must-attend meeting.

Podcast: Perspective Gained at HIMSS 2019

We’ve reached a tipping point in oncologic care, according to Andrew Pecora, M.D., chief innovation officer at Hackensack Meridian Health. One that requires highly specialized, highly intelligent tools.

Here’s the challenge: “Knowing exactly what to do — what’s the best care option to offer the patient in front of you – is rapidly becoming impossible,” Pecora, an oncologist by training, said before a room of several hundred attendees at HIMSS 2019 in Orlando, Florida.

LISTEN: Making the Most of Your HIMSS Experience

To Pecora’s point, the resources flowing into cancer research have grown drastically in recent decades. A quick PubMed search of the term “cancer” returns 70,438 published studies in the year 2000, 116,411 in 2010 and 178,078 in 2018. That breaks down to 192, 318 and 487 per day, respectively, and that’s only taking into account studies that can be found through a single publicly available database.  

As if that were not enough, oncologists must also remain abreast of new therapies coming to market, plus all the distinct characteristics of individual patients including their social determinants of health, and how their physician peers are handling similar cases.

If those complex data points were to come together at the point of care in an intelligible way, it could inform clinical decision making and help health systems move towards a better answer for one of the most perplexing questions in the industry: How can we improve outcomes for patients while reducing the total cost of care at scale in a practical and clinically acceptable way?

Pecora set out to create such an artificial intelligence-driven point-of-care data aggregation tool with the help of IBM’s Watson for Oncology. The tool would simultaneously pull data from clinical trials and real-world results, present unique patient characteristics from the EHR, include each patient’s social determinants of health, and benchmark against patients with similar characteristics who had been previously treated. Then, that data would be combined to arrive at an AI-generated treatment suggestion.

“We thought we were geniuses,” Pecora said, describing the moment his idea became reality. “But the physicians said we had to show them data that the experts actually agreed with.”

Pecora tapped three leading breast cancer experts to suggest treatment approaches on 88 cases. Of the 223 responses, 78.5% agreed with the Watson for Oncology recommendation for the best possible treatment approach, 9.4% of recommendations were listed as clinically acceptable, and 12.1% of recommendations were listed as not recommended.

The next hurdle was to demonstrate that presentation of the data would result in changed clinical decision making at the point of care, Pecora said. He polled four solid tumor doctors and 6 hematologic malignancy doctors who didn’t typically take care of breast cancer on 339 breast cancer cases.  

62% of the time, their choice agreed with Pecora’s results, 13% were clinically acceptable, and 24% of the time their choice was deemed by the system to be inappropriate care, he said, adding that their care pattern match was only 4%.

“So, if you show doctors at the point of care what experts think is appropriate and what the literature says might be best, the actually change their behavior,” Pecora said, adding that he believes he now has evidence to support moving forward with this cognitive computing point of care decision support system, supplemented by real-world data to improve treatment selection of complex disease such as breast cancer, especially when delivered in non-expert care settings.

“By using point of care solutions using expert opinion and the world literature combined with real-world evidence so that doctors can’t say ‘you’re not accounting for my kind of patients,’ you can demonstrate not just that there is selection of care that may not be optimal,  but that you can change decision making before it happens at the point of care,” Pecora said. “You can improve outcomes for your patient, and if you do this at scale, reduce total cost of care for the population.”

Get the best insights in healthcare analytics 

Weighing the Benefits and Challenges of Interoperability

Treating Healthcare IT's Interoperability Problem

HHS Issues Draft Strategy to Reduce Health IT Burden

Articles

#HIMSS19: How Andrew Pecora, M.D. is combining the literature with social determinants of health and previous cases to inform clinical decision making at the point of care.

Serving Docs the Right Data at the Point of Care

Healthcare Analytics News first launched in September 2017. It was less than two years ago, but so much in the world of digital healthcare has changed. Now, anyone with a few hundred bucks can suddenly wear an 

. The world’s largest retail giant made a billion-dollar 

. Millions of patients’ medical records have been 

The list goes on and on. In fact, there’s probably only one safe prediction in digital healthcare: Change is coming, and it’s coming fast.

In many ways, that’s great news. There’s so much about healthcare that is begging for change — so many opportunities to handle problems and processes more securely, with less risk and more efficiency. There’s little doubt that the tools of digital health have an important role to play in helping us make it happen. And to make the most of them, 

But that’s easier said than done. Change is painful, uncomfortable and expensive. And the pathway that’ll take us from status quo to the healthcare of tomorrow — healthcare’s digital transformation pathway &mdash; is fraught with uncertainty, distractions and blind curves. Odds are that we’ll encounter snake-oil peddlers and 

 that could set us off course. And if we stare down at our feet for too long, we might forget why we set off on this journey in the first place.

But if we keep our heads up and eyes open, we’re sure to find travelers who’ve 

. Experts who know it like the back of their hand. Leaders who are dedicated to helping others get to their destination as safely as possible. Sages who’ve made their life’s work about building tools that make the journey simpler, smarter and more secure. Unlike the snake-oil peddlers, these folks aren’t using their wits just to make a buck, but to make meaningful change — the kind that’s not so painful after all.

. They can point us to the people, places, companies and institutions that are laser-focused on pioneering new paths toward our healthcare goals. They can point us to the trailblazers who have succeeded and can help us replicate their successes, and spotlight those who have failed in order to help us avoid their failures.

That’s why Healthcare Analytics News is becoming Inside Digital Health. We’re here to connect you with these leaders so we can all work together to achieve a common goal: turning a risky, uncertain and costly digital transformation into a safe, secure and profitable one — for your health system, its stakeholders, employees and patients.

Our mission is to help you, the leaders of American health systems, to process actionable insights from the digital health hype. You can count on us to consistently deliver quality information, insights and engagement that empower you to make the right decisions — decisions that can help you move your health system into the future with confidence.

, and discover the world of opportunity and empowerment at Inside Digital Health.

Our mission is to help you, the leaders of American health systems, to process actionable insights from the digital health hype.

Healthcare Analytics News Is Becoming Inside Digital Health

In healthcare, a successful digital transformation depends on informed strategies, diverse connections and powerful tools. Fortunately, all three can be found at HIMSS, the industry’s most prominent annual live meeting.

With more than 44,000 minds roaming its corridors and roughly 1,400 companies exhibiting their latest advancements, odds are that the solution to your most pressing healthcare headache — no matter how niche it might be – is lying in wait at HIMSS.

At the same time, finding yourself suddenly surrounded by 44,000 minds and 1,400 companies can be pretty stressful. Who’s selling me my next big win versus my next big loss? Who’s got my best interest at heart and who’s only thinking about themselves? Questions abound and answers are unique to each attendee.

So, it’s important that everyone in attendance define their goals beforehand. But don’t take it from us — editors Tom Castles and Jack Murtha are only attending their second HIMSS conference this year. Instead, take it from Geeta Nayyar, M.D. and Janae Sharp. These two HIMSS social media ambassadors and Healthcare Analytics News advisory board members have been to more HIMSS conferences than they can count, and they join us on this week’s episode of Data Book to talk about survival tips at the industry-leading event.

We also pull in a valuable webinar segment with Denise Hines, DHA, PMP, who currently serves as chief Americas officer at HIMSS and brings years of insights to the table.

There’s something for everyone in this week’s podcast. Whether you’ve never even heard of HIMSS, or this is your first time attending, and even if you thought you knew absolutely everything about the big show, we’re sure you’ll learn a thing or two.  

So sit back and enjoy. And, if you plan on heading down to Orlando this year, we hope to see you there!

Whether you’ve never heard of HIMSS, this is your first time attending, or you think you know everything about the big show, you're sure to learn a thing or two on this week's podcast.

Podcast: Making the Most of Your HIMSS Experience

Barbara L. McAneny, M.D., is a board-certified medical oncologist and hematologist, and the 173

 president of the American Medical Association (AMA). We invited her into our studios in Cranbury, New Jersey to talk strategy: How does the AMA aim to shield its constituents from physician burnout?

 Physician burnout is very much a problem, actually. Four hundred physicians kill themselves every year — 100 medical students. This is not acceptable, and we have to address this.

The American Medical Association (AMA) has recognized this as a major public health problem and we consider it "the fourth pillar." Instead of the triple aim, it’s the quadruple aim now. It should include physician wellness, because if you're not a healthy caregiver, and if you're not able to give of yourself to your patients, you don't do as good a job. How can you be empathetic if you're hurting that badly? We are working very hard with that.

>> Read: Fixing Physician Burnout Is More Than Just the Decent Thing to Do

We think that the electronic health record (EHR) dysfunction is a symptom of the burnout. It's the most obvious interface to the physician. But the real problem, I believe, is lack of control. That instead of being able to say, "I've been trained as a professional to know exactly what the patient in front of me needs," to be able to explain it to that patient, etc. First, you're on a treadmill. You don't have time to sit and explain it to the patient. You don't have time to make that relationship with the patient. Because your hospital, if you're employed there, is focusing on how many RVUs you can churn out every day, rather than whether or not you have a good relationship with that patient.

And then once you figure out what the best treatment plan is, you have to go and play "Mother, may I?" with the insurance companies, which can take days and is very frustrating for physicians. And then you have to tap into the electronic health record all of these meaningless quality measures that don't change what we do every day.

So we did a study at the AMA that showed that for every hour that a doctor gets to spend talking to a patient, which is the part of healthcare that keeps doctors happy as well, we spend two hours tapping on a computer putting in data, which is the part of healthcare that doctors can't stand.

We really are working now with a lot of the EHR vendors and with the next generation of people who are working with creating new apps and new devices so that we have physician input at the beginning so that we can create an EHR that actually helps me take care of a patient, and not just helps me create a bill, which is not the goal of the physician.

>> Read: Leaders Weigh In on Solutions for Physician Burnout

So what we want in an electronic health record, what would make it into something that physicians liked, would be if when I see a patient, I can pull up their genomic tests and have it help me interpret those tests. Because no one's going to be able to keep up with the tsunami of information that's coming at us, and which new genome mutation is important for this cancer, for this patient, and how does it interact with the other ones. Which drugs are correlated with that mutation?

I would love to be able to have at my fingertips some decision support to help me with that. To be able to turn that computer around and show the patient, "This is what's going on," rather than having it be something that I have to do on the side to satisfy documentation requirements.

So we're continuing to work with a lot of the EHR vendors, we're working with the insurance companies for prior authorization fixes so that we don't have to spend all that time on the phone playing "Mother, may I?" And see if we can't get some of the burdens of care off of physicians' desks and let them go back to patients.

Why C-Suites Need to Get a Grip on Physician Burnout

Medical Scribes Can Cut Physician EHR Time and Boost Productivity, Satisfaction

Helping Healthcare Workers Reach Their Full Potential

Videos

400 physicians kill themselves every year. Here’s what the AMA is planning to do about it.
 

How the AMA Is Tackling Physician Burnout

The U.S. Food and Drug Administration has approved the SynchroMed II myPTM Personal Therapy Manager for patients with chronic pain, according to Medtronic, the device’s manufacturer.

The device allows patients to alleviate unpredictable pain by delivering on-demand drug doses within the therapeutic limits set by their physicians. It works with the SynchroMedII Intrathecal Drug Delivery system, also known as the Medtronic pain pump, which delivers medication to the fluid surrounding the spinal cord to relieve chronic pain. According to Medtronic, the implantable pain pump provides long-term pain relief at lower doses and with fewer side effects compared to oral pain medications and may allow some patients to eliminate the use of systemic opioids.

“Enabling patients to adjust their treatment provides them with some independence to control their pain and gives me confidence knowing that they are getting pain relief without oral opioids. The Medtronic pain pump and myPTM are powerful tools to safely treat chronic pain including intractable cancer pain," said John A. Hatheway, M.D., owner and provider at Northwest Pain Care in Spokane, Wash.

The approval preceded an announcement from FDA Commissioner Scott Gottlieb, M.D., whose tenure as agency head has been characterized by dozens of initiatives aimed at curbing the opioid crisis, including many that leverage high-tech tools, big data analytics and machine learning algorithms.

>>> Read: Rise of the Anti-Opioid Algorithm

The most recent announcement shows that new regulatory authorities will assist the agency in more forcefully addressing the opioid crisis, with authority granted by the newly enacted Substance Use-Disorder Prevention that Promotes Opioid Recover and Treatment (SUPPORT) for Patients and Communities Act.

The act “grants the FDA additional authorities that we believe will meaningfully advance our efforts,” Gottlieb wrote before uncovering four new areas for prevention of opioid abuse:

Efforts to decrease exposure to opioids as a way to prevent new addiction

Advancing innovation in pain medicines that don’t have the same risks as opioids

Development and use of better treatments to help those with opioid use disorder

Increasing enforcement and interdiction work aimed at illicit drugs like fentanyl

>>> Read: FDA Approves Wearable Device to Combat Opioid Withdrawals

Medtronic’s new device approval appears to fall in line with the second and third arms of the initiative. The company describes myPTM as an easy-to-use application on a touchscreen Samsung J3 smart device that’s customized to empower patients to manage their pain. Additionally, healthcare providers can set daily therapeutic doses and allow for on-demand drug delivery. myPTM features clear bolus delivery, access to therapy details, and lockout alerts if patient demand exceeds prescribed limits. Physicians also have access to reports that provide insights needed to track progress and collaborate on therapy goals with their patients.

Oral opioid misuse is a significant issue, Medtronic said in the statement. “It's more important than ever for patients suffering from chronic pain to have access to proven alternatives. Targeted drug delivery (TDD) may enable systemic opioid reduction or elimination and may be considered as an alternative to oral treatment for chronic pain.”  

In a single-center, retrospective chart review (n=99) of patients with chronic non-malignant pain who agreed to transition from systemic opioids to TDD with the goal of eliminating systemic opioids, 84 percent were able to eliminate systemic opioids within one year, the statement read.

"We are striving to simplify targeted drug delivery therapy to make it more accessible. The Control WorkflowSM and Clinician Programmer provide physicians with tools to effectively administer the therapy, and the myPTM provides customized pain relief options for patients," said Charlie Covert, vice president and general manager of the Targeted Drug Delivery business, part of the Restorative Therapies Group at Medtronic. "As the opioid crisis continues, we are inspired by the Medtronic Mission to continue to innovate and expand access to care for patients who may benefit from our therapies, which have the potential to eliminate the need for oral opioids."

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The device, called the SynchroMed II myPTM, provides a substitute to oral opioids for patients with chronic pain, according to Medtronic. 

FDA OKs Device That Allows Patients to Self-Administer Opioids Into Their Spine

Browsing Reddit the other day, I happened upon a thread deep in the belly of the subreddit /r/medicine. It’s a hub of earnest physician feedback that provides important insights, especially for the health-tech community, whose role in mitigating the industry’s challenges and doubling down on its strengths becomes clearer with every new post.

If you want to get a feel for the tone of the conversations that take place in this virtual meeting place, look no further — the post below is the perfect microcosm for the purpose. Let’s take a closer look:

For anyone who takes misconceptions about physicians at face value, this might be a perplexing question. Aren’t all doctors happy, rich and living luxurious lifestyles?

No need to justify that one with a response. Many in the health-tech community have a good grip on the challenges inherent in both making an entrance into the world of medicine as a student and then sustaining a career in the industry thereafter. But the truth is that this question becomes increasingly relevant as physician burnout captures more headlines and we hear more about aggressively competitive medical schools, the increasing share of administrative tasks in physician workflows and the windfall of clunky tech entering the continuum of care.

>> READ: Why C-Suites Need to Get a Grip on Physician Burnout

So what did the medical professionals of Reddit have to say to this question? Fittingly, 570 responses ran the gamut from feverish regret to lukewarm indifference to pure gratification. But upon closer inspection, there's an observable pattern running through many of the responses: Physicians’ happiness or disappointment in their career was linked to their ability (or inability) to actually 

 their job. By and large, when we empower doctors to help patients solve problems, they’re happy. When we don’t, they aren’t.

Why Do People Make Medicine Their Life’s Work?

Here are a few examples from responses to the reddit post:

Medicine “is an interesting field, it's just that the interesting stuff comprises a smaller and smaller proportion of your time these days,” one user wrote.

“I definitely feel like a cog in the machine of medicine a lot of days. I often feel completely powerless to help people. Sure, there are a lot of things that suck about the job but, there are going to be just as many frustrating aspects to any career you choose,” said another.

And finally, “Sold my youth to learn the art of medicine to only be encumbered by debt, administrative work, productivity demands, dwindling public opinion and poor work life balance.”

Now before we spend the rest of our time together wallowing in sadness, it’s worth noting that many doctors said they’d do it all over again in a heartbeat. One user even said they plan to “die at the microscope,” and if they got a second chance, they’d take it without a second thought.

From all of these responses, one thing is clear: Physicians are driven, passionate people. They are committed to doing good work and making a difference. When we get in their way and prevent them from doing that, what are we left with?

The world we live in now. One where physician burnout 

. That new normal is cyclical, and it goes something like this:

Increasing workload leads to physician burnout

Physician burnout leads to poor patient outcomes and decreased health system profits

Poor patient outcomes and decreased profits lead to increased physician workload

Increased physician workload leads to physician burnout

>> READ: Fixing Physician Burnout Is More Than Just the Decent Thing to Do

This problematic cycle means that the medical community cannot possibly do its best for patients. It also means that 

billions of dollars are being left on the table

. And where the dollars go, the solution-wielding startups flow. Every day it feels like a dozen new health-tech startups who claim to possess the burnout panacea emerge from the woodwork, positively drenched in hype and with a paucity of use cases to support their claims.

Many of these innovators, while pure in their intentions, may be 

to the pile of problems that health systems face — a new stopping point in the electronic medical record (EMR) or a new compliance checkbox, for example. What healthcare needs, rather, is innovation that 

 steps from physician workflow. Good ideas that 

mouse clicks in the EMR that stand between a physician, a patient and a prescription.

It’s like putting a hole in a bucket — it’s the only thing you can 

 from its weight. The only addition the world of health tech needs right now is one that can reduce the number of menial tasks standing between physicians and the extremely meaningful work they do for patients.

So what can healthcare executives do to accomplish that goal? First, if you aren’t already, begin measuring your staff’s engagement at work. It’ll provide the insight needed to improve that engagement. As renowned management consultant Peter Drucker once said, “If you can’t measure it, you can’t improve it.”

Second, begin baking physician well-being into your business strategy. Each piece of tech that is being considered for implementation — regardless of its purported ROI and efficiency claims on paper &mdash; must pass the “physician well-being” test. If the tech stops physicians from doing their jobs and interfacing with patients, it’ll prevent them from enjoying the work they do and will lead to disengagement, which hurts patients and so on.

Finally, realize that the future of medicine depends on the strength of its purveyors. Not only is physician burnout hurting current physicians, it’s also deterring would-be entrants into the profession, who are increasingly opting for less demanding work and higher pay in industries like tech and finance — an especially disconcerting detail in the face of a looming physician shortage and an increasing burden of chronic disease.

Making the delivery of care more efficient and engaging is about subtracting unnecessary steps along the way. It’s about removing whatever prevents physicians from building trust with their patients. And it’s about showing physicians that their work is valuable and makes a difference. After all, the worst thing we could do for children who dream of becoming healers is to make them regret following their dreams.

Navigate the digital transformation with confidence. 

Physician Burnout and the Clinical Divide

Doctors Aren’t Luddites, But their EHRs Are Broken

Keep Physicians in the Healthcare Cockpit

The only tech additions that medicine needs right now are ones that cut out stopping points between physicians and patients.

Health Tech Must Focus on Subtracting Steps From Physician Workflow

 that run the gamut from outdated payment models and frustrating tech to a patient population plagued with chronic preventable disease. It’s an ostensibly never-ending list, and woven deeply into the fabric of each one of these issues is a single, pervasive notion: The physicians tasked with whittling down this mountain of problems are burned out.

Lately, no trend has permeated the discourse around medicine’s triumphs and challenges quite like physician burnout. Most of the hundreds of doctors I’ve interviewed acknowledge its detrimental existence, and online, where venting is ubiquitous, you can’t make it more than a few dozen tweets without hearing about burnout or seeing it in action.

Physician burnout is the topic of thousands of physician-authored op-eds, blog posts and conference presentations. And recently, the literature is making strides toward catching up and lending credence to the conversation: A new 

 in JAMA Internal Medicine has found that physician burnout is associated with suboptimal patient care, and that physicians with burnout are twice as likely to be involved in patient safety incidents, twice as likely to deliver sub-optimal care to patients owing to low professionalism and three times more likely to receive low satisfaction ratings from their patients.

High depersonalization in physicians was particularly indicative that patient care was at risk. It was the factor most strongly associated with reduced prof

essionalism, patient safety incidents and lower patient satisfaction, which suggests that physician burnout is perceptible to patients, according to the authors.

Resident and early-career physicians reported much stronger links between burnout and low professionalism compared with studies of middle- and late-career physicians. “It is likely that burnout signs among residents and early-career physicians have detrimental associations with their work satisfaction, professional values and integrity. Healthcare organizations have a duty to support physicians in the demanding transition from training to professional life,” wrote the study’s authors, led by Maria Panagioti, Ph.D., of the University of Manchester.

Is it any wonder that overstressed, overburdened, overworked physicians are performing poorly? Of course not! The wonder (or the blunder, to give it a more apt name) is that we allow it to continue happening.

Think about how delicately we coddle and track our professional athletes so that their performance is optimized for game time. Their meals, training schedules, sleeping patterns, transportation and tools are all managed for them. Then, on game day, when they show the slightest signs of fatigue, they’re pulled to the sidelines and supported by their teammates.

Now think about a physician’s workflow. Who can count the number of times they’ve listened to their physician peers complain of not having enough time during a workday to eat a meal, or that they could hardly keep their eyes open during the 23

 hour of their shift? There’s also the dread that comes with knowing that each hour of practice might result in several hours of matching paperwork, data entry and administrative tasks. Support is scarce.

On one hand, athlete burnout would mean a poor fan experience and a PR nightmare for the leagues that hire them. As it turns out, the same is true for health systems — the patient experience is suboptimal, and hospital systems are publicly struggling (and, in some cases, publicly neglecting) to tame the burnout beast, even though it costs them untold billions, according to the review.

“We found that physician burnout is associated with a reduced efficiency of healthcare systems to deliver high-quality, safe care to patients,” study authors wrote. “Preventable adverse events cost several billions of dollars to healthcare systems every year. Physician burnout therefore is costly for healthcare organizations and undermines a fundamental societal need for the receipt of safe care.”

One would think that such a gaping hole in the efficiency of healthcare delivery would become the Holy Grail of operations optimization and revenue growth for hospital executives. And while we can’t be sure of what’s atop the to-do lists of every C-suite, the evidence suggests that it’s probably not the wellbeing of their physician workforces, yet.

Previous studies have suggested that physician burnout 

 that 76 percent of physicians suffer from sleep loss due to stress. 

 show that self-reported burnout affects most physicians and continues to grow steadily, year over year. With burnout comes increasingly common suicidal ideation among physicians. More than 

 every year — an especially disconcerting trend when juxtaposed with the looming physician shortage.  

 to Panagioti’s study, Mark Linzer, MD, of the University of Minnesota, wrote that executives often ask him the same questions about burnout: “What should we do? What will it cost? How will this affect productivity, quality and physician turnover?” These questions underpin the notion that executives are not implementing sufficient measures to reduce burnout in the present — and that they are not convinced of the value of implementing strategies to reduce burnout in the future.

Can you blame C-suites? Sure, if you want. But they’re among a group of complicit parties that also includes the physicians themselves. Still, the previous line in Linzer’s editorial response throws executives a bone: “How successful can we be at reducing and sustaining burnout at low levels, given that regulations, publicly reported patient outcomes and complex medical record systems have brought new and enduring challenges to the practice of medicine?”

There’s also a wide knowledge gap. While this systematic review and meta-analysis expands our understanding of how burnout changes outcomes, it also leaves us with more unanswered questions. Of note, Linzer admits that medicine hasn’t identified cohesive answers to the following questions:

Which workflow redesigns best improve efficiency and reduce burnout?

What aspects of the electronic medical record can be addressed to lower stress?

How can we reengineer workplaces for less chaos and burnout?

What work condition modifications can address burnout in trainees and early-career clinicians?

What efforts can narrow the gender gap and reduce burnout among female clinicians?

Does burnout reduction improve productivity, quality, safety and patient satisfaction?

What interventions can reduce burnout in both support staff and clinicians?

Will work condition changes lead to more trainee interest in primary care?

Which policy or regulatory changes can improve clinician satisfaction?

In the absence of a clear understanding of burnout’s causes and effects, it’s tough to determine the best path forward. What’s worse, “answering these questions is challenged by there being few funders who have entered this field in a substantive manner,” Linzer wrote. In other words, we aren’t investing enough time, money and research into understanding burnout, especially given that we have a better idea of what it’s costing us thanks to this systematic review and meta-analysis.

On one level, directing innovation toward new ways to reduce burnout promises an incredible return on investment, because “physician wellness and quality of patient care are critical and complementary dimensions of healthcare organization efficiency,” Panagioti and colleagues wrote. “Investments in organizational strategies to jointly monitor and improve physician wellness and patient care outcomes are needed… They should therefore be evaluated at scale and implemented.”

On another level, it’s just the decent thing to do.

The problem is also hurting patients and costing health systems untold billions, according to a new systematic review and meta-analysis. 