Physician Burnout and Wellness

Advocacy

Physician burnout and its corollary, physician wellness, is a major point of emphasis for AAPM&R. Academy leaders are aware of the currently available data that demonstrates our specialty to have one of the highest rates of burnout, dissatisfaction, and unhappiness. Burnout in medicine is commonly defined by the following three criteria:

  • Emotional exhaustion
  • Depersonalization (cynicism or callousness)
  • Loss of personal accomplishment (lack of work fulfillment)

It has been argued that burnout in medicine is a public health crisis. The impacts of burnout include:

  • Loss of individual and organizational productivity
  • Risks to mental and physical health/quality of life/suicide
  • Eroding quality of patient care and safety
  • Diminished patient satisfaction
  • Loss of group (team) morale

It is understood that clinician well-being is a complex problem. Burnout is fueled by factors at the individual, local, and national levels. There is a growing understanding that a physician’s local work environment may contribute the greatest to burnout including:

  • Practice inefficiencies and insufficient resources
  • Misalignment of professional values between faculty and leadership
  • Increasing regulatory burden

The Academy is increasingly concerned about the cumulative risk to our members and in turn the specialty as a whole. Physiatry has been shown to be the least “happy” specialty. The combined detrimental effects raise serious alarms relating to:

  • Individual member health and well-being
  • Specialty cohesiveness including recruitment, retention, and reputation
  • AAPM&R’s growth potential

There is a growing national narrative to address and reverse the trend in physician burnout. The so-called triple aim in medicine has now been expanded to the quadruple aim:

  • Increase value of care
  • Improve the patient experience
  • Enhance population health
  • Regain the joy of work

AAPM&R leaders recognize this escalating burden on our members. In 2019, Academy leadership commissioned a Board-level task force to further assess this dynamic landscape. This task force has instituted steps to inform members on this topic and advocate for our members in this arena. 

Academy volunteers and staff leaders understand our members’ plight and recognize that the solution to burnout should not, and cannot, be borne individually by members. The historical model of treating burnout solely through individual directives (e.g., “stress reduction”) is inadequate and inappropriate. Given the complexity of burnout, there are multiple strategies that need to be implemented. 

The Academy provides information, resources, and tools that focus on the barriers impacting the specialty at a national level and on the daily challenges of practicing medicine. The following represent the current direct and indirect initiatives and actions that the Academy has instituted to support physiatry wellness:


National Level:

Major Advocacy Win! Removal of Post-Admission Physician Evaluation (PAPE)

On August 4, 2020, CMS decided to remove the post-admission physician evaluation (PAPE) documentation requirement, effective October 1, 2020, as part of its Inpatient Rehabilitation Facility (IRF) Prospective Payment System Final Rule for 2021.

AAPM&R has long advocated to reduce burden for physiatrists by streamlining administrative documentation. Since 2013, our Health Policy and Legislation Committee has been advocating to revise redundant documentation requirements in IRFs, between the pre-admission screening, the previously required PAPE, and individualized overall plan of care (IPOC). IRFs have more documentation requirements than other settings and IRF admissions are often deemed unnecessary by Medicare auditors based on technical errors in documentation, rather than the patient’s actual medical need for an IRF admission. With one fewer documentation requirement in IRFs, physiatrists will be able to spend more time caring for their patients rather than ensuring redundant documentation is completed in tight timelines.

CMS’ decision to remove the PAPE is a direct result of our persistent advocacy*.

As proposed, CMS also codified into regulation certain elements of the pre-admission screening (PAS); however, they have removed three elements from the Medicare Benefit Policy Manual including expected frequency and duration of treatment in the IRF, any anticipated post-discharge treatments, and other information relevant to the patient’s care needs.

Comment/Sign-On Letters:


Other National-Level Resources:


Institutional Level:


Individual Level:

  • PhyzForum – access 24/7 to peers from all over the country and world who may be experiencing similar or different practice challenges and an opportunity to connect with them.
  • Member Communities – an opportunity to connect with peers on what matters most to the individual physiatrist.
  • PM&R Journal articles that discuss burnout and other environmental influences of burnout.
  • Mentor Program – an avenue to connect with seasoned physiatrists who have seen it all and can offer guidance and support.
  • AAPM&R/AMA Video Series – this series includes eight 5-7-minute videos on practical tips related to burnout, primarily focusing on practice efficiencies and processes that can lead to reduced burnout. Videos were tailored for physiatrists from the AMA STEPS Forward campaign.
  • MemberDeals – members receive discounts on vacations, movie tickets, car rentals, etc. through AAPM&R that allows them to take full advantage of personal time, when able.
  • SoFi Discounts – special student loan refinancing discounts for members to reduce financial burdens that can lead to burnout.
  • Insurance Discounts – members receive reduced rates on insurance.