To strengthen our health system, we must start with primary care

By Keith Hovan

Thriving primary care practices are foundational to our entire health system, so widespread reports of burnout among primary care physicians (PCPs) are cause for great concern.  Beyond the stress of providing care during a two-year pandemic, navigating the complexities of the electronic health record (EHR) has long been a drain of time and energy.  Because PCPs treat the entire patient, using the EHR effectively is much more burdensome than for specialists. Furthermore, in most marketplaces there is a dearth of behavioral health professionals, so PCPs are called upon to treat patients’ mental and emotional needs, as well as promote their physical well-being. They are overburdened by the demands placed upon them, and as a result, many PCPs say they no longer find joy in what they do.

PCPs’ ability to serve our communities by treating the entire patient from a holistic point of view is critical to not just individual health systems, but to healthcare across the nation as a whole. I believe the depth of the crisis in primary care demands a response from our entire industry, both for the well-being of our primary care colleagues and for the health of the communities we serve. We must be willing to acknowledge what isn’t working and take a new approach to support them.

Dig deeper to discover what support is needed.

Several experienced PCPs have shared with me that they are considering retiring early. The extreme challenges of COVID, combined with the already onerous EHR, has been the last straw for many of them. During the pandemic, many PCPs noted that finding a hybrid way to use telehealth had become overwhelming.

We must take the time to understand the burden placed on these physicians. As CEO, I had a responsibility not just to lend a listening ear to our PCPs but also to get them the support they needed to ease the burden. My team and I were determined to find which physicians were struggling the most. We looked into our EHR system and could see the physicians who were making entries in their charts at 1 a.m., way beyond the bounds of their regular clinic hours. We worked with the physician group to give at-the-elbow support to these providers to help them navigate the EHR, patient complexity, and technological changes, so that they could see some reasonable improvement in their work-life balance.

Create an internal support system.

I’ve observed that the PCPs entering the profession don’t always get the onboarding and specific system training they need and are left to sink or swim. This is detrimental, but understandable. Their partners in practice are busy themselves trying not to drown in the amount of work to be done.

PCPs’ daily schedules are already full to overflowing, but we must ensure that PCPs have dedicated opportunities to gather to meet with new physicians. Encourage one or two more senior physician leaders to facilitate a forum for them to get to know each other, problem solve about entrance into the specialty, and offer training on the various systems of the practice. It will build camaraderie and create a base of support and encouragement from within their own practice group that will be invaluable in the long term.

Allow everyone to work at the top of their license.

One strategy to improve the work environment for PCP’s is to have all staff working at the top of their license. What does this mean? It means that the PCP should delegate responsibilities that are not specifically required to be performed by them, those tasks that do not require their professional interpretation and/or level of clinical judgement. The same is true for the other professionals in the practice including Advance Practice Professionals, Registered Nurses and Medical Assistants. Allowing the performance of highly routine clinical and administrative activities that do not require an advanced level of training should occur at the most appropriate level within the practice.

The potential positive effects of the PCP delegating work to the most appropriate level can be many. Medical assistants and registered nurses working in the primary care setting will have increased clarity of their roles based on their respective training, knowledge, expertise and skills. This often leads to increased satisfaction in their roles and a sense of professional pride in their work. The PCP in turn will have the ability to manage the team under their supervision and utilize their unique skills and expertise to determine the best plan of care for each of their patients. As a result, PCP burnout can be reduced and job satisfaction increased as they more fully utilize their education, training, and expertise when working with individual patients. This does require that the PCP work on skills such as team building within their practice which often has the added benefit of building trust between team members at all levels and results in higher levels of performance.

Treat core staff better.

Without passionate, skilled people surrounding them, PCPs simply cannot provide the level of care they desire to give their patients. Though many PCPs offer telehealth appointments, I really do believe that most physicians want to see their patients in person. After all, it’s hard to diagnose an intra-abdominal issue or set a broken bone over the phone. But we need that core staff—schedulers, receptionists, medical assistants, etc.—to make that happen.

To retain a well-trained core staff, the healthcare industry must make changes. For many entry-level employees of primary care facilities, the risks that working on the front lines of the pandemic posed to their own and their family’s health, outweighed the benefits of working in the healthcare profession. This was especially true when they realized they could make more money delivering for Amazon or FedEx, for example, and work by themselves and stay protected. Employees at every level need to be treated better, including providing a living wage for those who are on the front lines of our practices to help our providers care to the best of their ability.