Original article
Relationship Between Clerical Burden and Characteristics of the Electronic Environment With Physician Burnout and Professional Satisfaction

https://doi.org/10.1016/j.mayocp.2016.05.007Get rights and content

Abstract

Objective

To evaluate associations between the electronic environment, clerical burden, and burnout in US physicians.

Participants and Methods

Physicians across all specialties in the United States were surveyed between August and October 2014. Physicians provided information regarding use of electronic health records (EHRs), computerized physician order entry (CPOE), and electronic patient portals. Burnout was measured using validated metrics.

Results

Of 6375 responding physicians in active practice, 5389 (84.5%) reported that they used EHRs. Of 5892 physicians who indicated that CPOE was relevant to their specialty, 4858 (82.5%) reported using CPOE. Physicians who used EHRs and CPOE had lower satisfaction with the amount of time spent on clerical tasks and higher rates of burnout on univariate analysis. On multivariable analysis, physicians who used EHRs (odds ratio [OR]=0.67; 95% CI, 0.57-0.79; P<.001) or CPOE (OR=0.72; 95% CI, 0.62-0.84; P<.001) were less likely to be satisfied with the amount of time spent on clerical tasks after adjusting for age, sex, specialty, practice setting, and hours worked per week. Use of CPOE was also associated with a higher risk of burnout after adjusting for these same factors (OR=1.29; 95% CI, 1.12-1.48; P<.001). Use of EHRs was not associated with burnout in adjusted models controlling for CPOE and other factors.

Conclusion

In this large national study, physicians' satisfaction with their EHRs and CPOE was generally low. Physicians who used EHRs and CPOE were less satisfied with the amount of time spent on clerical tasks and were at higher risk for professional burnout.

Section snippets

Methods

A description of the survey administration process, the participation rates, and the demographic characteristics of the overall survey population has been previously reported.5 The physician sample for the survey was assembled using the American Medical Association Physician Masterfile, a nearly complete record of all US physicians independent of American Medical Association membership, and included physicians of all specialty disciplines. The survey was administered from August 1, 2014,

Results

The personal and professional characteristics of the 6560 physicians who were in active clinical practice at the time of the survey who were included in this analysis are shown in Table 1.

A description of the electronic practice environment of participating physicians is shown in Table 2. Of the 6375 physicians who replied to the question about whether they used EHRs, 5389 (84.5%) indicated that they did. Of the 5892 physicians who indicated that CPOE was relevant to their specialty, 4858

Discussion

The present study chronicles the widespread evolution of the electronic environment in the US healthcare system and its effect on physicians. In 2008, less than 15% of medical practices used EHRs and less than 5% had fully functional EHRs that incorporated test ordering, electronic prescribing, decision support tools, and medical images.32 By 2012 these proportions had increased to 72% and 40%.33, 34 In the present study of US physicians across all specialties, more than 80% reported using EHRs

Conclusion

Electronic health records, CPOE, and patient portals are here to stay. These tools hold great promise for enhancing coordination of care, reducing errors, and improving quality of care.10, 11, 12, 13, 14, 15, 16 In their current form and implementation, however, they seem to have had a variety of unintended negative consequences that reduce efficiency, increase clerical burden, and increase the risk of burnout for physicians. Further studies are needed to investigate whether the associations

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  • Cited by (0)

    Grant Support: Funding for this study was provided by the Mayo Clinic Program on Physician Well-being.

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