There’s a public health crisis in our nation’s emergency departments. Is COVID-19 to blame?
Physician burnout has long been a problem in the health care industry. But according to a Medscape survey, burnout among emergency medicine doctors has been spiking these last few years in particular.
We know why, or we think we do: the global pandemic. But physicians say that its challenges account for only a part of the problem. Also weighing them down, they say, are burdensome bureaucratic chores, lack of respect from employers and colleagues, too-long hours, lack of autonomy, and lack of adequate pay.
Emotionally exhausted physicians may have a more negative attitude toward patients and treat them with less empathy than they would otherwise. The doctors’ sense of achievement and pride in their work also suffers.
The AMA discusses the situation in its Recovery Plan for America’s Physicians.
Staff shortages are one major reason for widespread burnout, which includes shortages of nurses, support staff, and physicians themselves. Another challenge is the overcrowding of emergency departments (EDs). EDs are too often boarding patients who are waiting to be admitted, as hospitals — struggling to return to profitability — fill beds with higher-margin elective surgeries.
The Front Door Is Stuck
As the front door of the hospital, the emergency department has a lot of responsibility. In emergency care, patients are seen without regard to medical necessity or ability to pay. The No Surprises Act (2020), which eliminated balance billing for out-of-network charges, has led to payers canceling provider contracts. These contracts previously offset EMTALA care (Emergency Medical Treatment and Active Labor Act), and for patients where the reimbursement is low, such as Medicaid.
Physicians are seeing large reductions in revenue even as medical malpractice insurance increases. Inflation remains high, and many are still servicing high medical school debt.
Health systems are instead focused on increasing elective surgeries and ambulatory services. When COVID restrictions were relaxed, these services had to be massively ramped up to handle long-deferred treatments. Patient wait times had already been a problem. Now the problem is worse with inpatient beds full and emergency departments overrun.
This congestion has led to frequent boarding of patients, who take up precious ED space while waiting for rooms to become available in ICUs, behavioral health facilities (a really big issue), or general medicine or surgery floors. Already understaffed emergency departments end up providing round-the-clock care to these waiting patients while also providing acute, stabilizing care to others. Waiting rooms and hallways are clogged and stress levels skyrocket.
Current Solutions Don’t Go Far Enough
There is no single solution. But many organizations are successfully using telehealth to better balance the load on ED physicians when traffic is high, to bring specialists to ED bedsides, and to facilitate transfers and placements.
Data-driven decision-making also helps emergency rooms to function more smoothly. d2i helps ED administrators to understand the gaps and bottlenecks they’re facing in detail as they search for solutions.
At the same time, healthcare organizations as well as professional organizations must advocate for policy that drives positive patient outcomes – something we are not seeing in the current climate. For physicians to find job satisfaction, they must be able to do their jobs, take care of patients effectively, and have the resources to do so.
Telehealth will offer some relief by addressing gaps in patient flow, as well as resource management, but ultimately well-intended programs like NSA and EMTALA will require public funding. The days of cost shifting through more lucrative commercial reimbursement will no longer sufficiently subsidize these programs.
At d2i, we want our clients to know we are strong advocates for emergency medicine physicians. While we advocate for more rational funding, d2i clients continue to leverage our solutions to prove their value to negotiate better contracts, improve patient flow and resource utilization, and reduce burnout. We invite administrators and physician groups to contact us to learn more about how d2i can help you.