Reducing Physician Burden



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 in all of medicine. 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:

Tri-organizational Workgroup Established to Inform the Design of Interventions to Reduce Burnout and Promote Professional Fulfillment Among U.S. Physiatrists

Physician burnout and its corollary, physician wellness, is a major challenge for physiatrists across all practice areas and settings. Physiatric leaders are aware of the data that demonstrates our specialty has 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)

These combined detrimental effects raise serious alarms relating to individual physician health and well-being; specialty cohesiveness including recruitment, retention and reputation; as well as organizational growth potential.

Collaborative Research Study

The aggregate PM&R responses from prior research do not drill down into the specialty enough to assist in identifying actionable interventions. Therefore, to gain further insight into the causes of burnout in physiatrists, AAPM&R, the American Board of Physical Medicine and Rehabilitation (ABPMR) and the Association of Academic Physiatrists (AAP) have entered into a collaborative project to address these issues. The tri-organizational effort will initiate and fund a research project—designed and conducted by the Stanford Medicine WellMD Center—to identify both cross-cutting issues as well as PM&R-specific drivers of burnout that can be translated into actionable and impactful interventions by the partnering organizations. 

In February 2023, our tri-organizational workgroup published the paper, “Occupational Characteristics Associated with Professional Fulfillment and Burnout Among U.S. Physiatrists,” which outlines characteristics of the work environment associated with professional fulfillment and burnout among U.S. physiatrists.

Most recently, we published a new paper in June 2024, "A qualitative study of strategies to improve occupational well-being in physical medicine and rehabilitation physicians," that builds on the previous paper's findings by investigating ways to address burnout in an independent cohort of physiatrists. 


Major Advocacy Initiatives: 

Prior Authorization Reform

AAPM&R has been working to reform prior authorization for several years due to the burden it puts on physiatrists and the barriers to rehabilitation care it creates.

What does AAPM&R prioritize in prior authorization reform?

  • The lack of transparency with plans using proprietary guidelines
  • The flaws of the “peer-to-peer” system
  • Decreasing lengthy response times from plans conducting authorizations

What is AAPM&R doing to advocate for prior authorization reform?

  • Advocating for the Improving Seniors’ Timely Access to Care Act, legislation to reform and streamline the prior authorization process under the Medicare Advantage program, since before its original introduction in the 116th Congress.
    • Please see the Regulatory Relief Coalition’s website for more information on the progress of this bill.
  • Advocating for the U.S. Congress to consider additional prior authorization reforms, including:
    • AAPM&R-endorsed legislation to implement a Gold Card program under the Medicare Advantage program.
  • Consistently meeting with the Centers for Medicare and Medicaid Services (CMS) and other Administrative agencies to discuss AAPM&R's priorities on prior authorization reform and reducing physician burden.

Recent advocacy efforts by AAPM&R on this issue include:

Additionally, please note the running list of comment and sign-on letters at the bottom of this page, which include many public statements from AAPM&R, as well as coalitions that AAPM&R participates in, advocating for prior authorization reform.

IRF Review Choice Demonstration (RCD)

CMS has begun to implement a “Review Choice Demonstration” (RCD) for Inpatient Rehabilitation Facilities (IRFs), which subjects selected IRFs to 100% pre-claim or post-claim review of their Medicare claims. While this demonstration has begun with all IRFs in Alabama, CMS is planning to eventually expand the RCD to all providers in four Medicare Administrative Contract (MAC) jurisdictions, covering 17 states, three U.S. territories, and the District of Columbia. CMS has publicly announced that while there is no set timeline yet, this program will next expand to Pennsylvania, Texas, and California.

AAPM&R has significant concerns with the IRF RCD project and has been a leader in opposing its implementation. This project will dramatically increase physician burden in a field already subject to onerous documentation requirements and serve as an unprecedented intrusion by CMS contractors in the exercise of independent physician judgment.

Recent advocacy efforts by AAPM&R on this issue include:

Please click here for more background on AAPM&R’s engagement on this issue when this program was first announced by CMS.

Additionally, please note the running list of comments and sign-on letters on this page, which include multiple comments on the IRF RCD.

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:

  • Reducing Physician Burnout: View this webinar from April 15, 2019
  • Maintenance of Certification® (MOC®) advocacy for changing requirements so they are less burdensome.
  • Advocacy on behalf of physiatrists’ practice and regulatory burden:
    • Fighting reimbursement denials.
    • Prior Authorization Reform advocacy.
    • Advocacy to streamline Inpatient Rehabilitation Facility paperwork and reduce onerous regulations.
    • Post-Acute Care Toolkit and Online Platform.
    • Advocacy to reduce the number of Inpatient Rehabilitation Facility claims denied by Medicare.
    • Responding to scope of practice concerns by non-PM&R health care providers, which may threaten the health and safety of patients and impact the livelihood of physiatrists.

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.
  • Insurance Discounts – members receive reduced rates on insurance.