Provider Burnout: Addressing the Latest Healthcare Crisis With Emerging Technology Solutions

Ryan Daniels, CFA, partner and group head of healthcare technology and services discusses provider burnout across the U.S. healthcare market, how its creating capacity issues in the industry, and the potential for technology solutions in other workforce investments to help reduce workloads and increase access to care.

Podcast Transcript

00:21
Chris T
This William Blair Thinking Podcast episode was recorded on July 1st, 2024.

00:25
Chris T
Hello everybody! On today's episode of William Blair Thinking Presents, we welcome back analyst Ryan Daniels, CFA, partner and group head of the healthcare technology and services sector. Ryan is joining us again to talk through his team's latest healthcare mosaic. It's a report they release every quarter, which sets out to cover a far-reaching topic of interest in the healthcare space. They analyze its impact to the broader healthcare marketplace. This particular report is called "Provider Burnout Addressing the Latest Healthcare Crisis with Emerging Technology Solutions" and focuses on just that. So, it's provider burnout across the U.S. healthcare market. How its creating capacity issues in the industry and the potential for technology solutions in other workforce investments to help reduce provider burnout and increase access to care. So, Ryan, with that, welcome back. I thought we could maybe start with a brief overview of the report, including what inspired you and your team to dig into this burnout topic in the first place, which arguably has gone a bit quiet in the mainstream media, but is, as you discuss in the report, still a very big problem.

01:29
Ryan D
Sure, Chris, I'd be happy to. And first off, thanks for having me back again. I always enjoy these sessions with you where we can highlight our mosaic report. So again, appreciate the opportunity to chat with you. Now regarding your question, a few points first. As you mentioned earlier, we do our healthcare mosaic reports each quarter, and our intent in doing so is to identify a trend in the healthcare market that we believe is really far reaching.

It's impactful, and it's picking up a lot of steam. As you'll likely recall, we've done these in the past on topics as far reaching as food is medicine to, emerging solutions in the employer market that they're implementing to reduce healthcare costs to this piece on provider burnout.

So, second, as to what inspired us to do this report, now we're really seeing a lot of focus on the topic of provider burnout and how to better manage this. And it's really more than ever before. I think a lot of this actually stems from the post-Covid impact on healthcare workers. put simply, it was a really difficult two to three years for providers. And, you know, after slogging through that, a lot of doctors and nurses are now starting to question their long term commitment to the field. And we're starting to see them exit in masses. In fact, in recent surveys, we've seen data that 93% of all physicians, they feel burned out on a regular basis, which is an exceptionally high percentage in our view. And a lot of this is driven by unsustainable workloads, especially with administrative tasks outside of normal office hours, which, given all the regulatory documentation and reporting requirements, consume about 15 hours a week for every provider in the United States.

And because of all these stresses, about 56% of providers indicate they may leave the field or reduce their patient facing hours in the coming years. And this data point in particular is really a wake up call for industry leaders, because, put simply, the key element in providing care at any delivery system is your caregivers. That's your real capacity constraint.

So, you know, if there's anything near this level of exodus from the market, it would be devastating. And that was a big driver, and key data point, that was behind doing the report. Now, another thing is we have a great quote in our report from the CEO of one of our covered companies that provides training in other workforce solutions to about half of all U.S. healthcare systems.

And he made the comment during the company's most recent earnings call and explicitly stated that, quote, “now more than ever, we leave healthcare CEOs are embracing the fact that their workforce is really their most valuable asset, and the staffing shortages that were exacerbated by the pandemic really serve to reinforce the ongoing importance of taking care of your workforce,” end quote.

So, again, it seems like there's really been an inflection point within healthcare executives in saying, look to address this topic. And then one final point before I go on too long, the US Surgeon General even recently issued a report on worker burnout in the U.S. healthcare system, calling it an urgent public health issue. So again, to hit your question directly, why now for this report, put simply, it appears to be a major issue at present, given the risk of near-term workforce destabilization, if this goes unaddressed. And it's really being recognized as a key issue by both leaders and regulators alike. It definitely makes for a compelling topic in our view.

04:42
Chris T
You start the report with the reasons why provider burnout and its negative consequences are critical to solve as they place the quote, “quadruple aim framework of the U.S. healthcare system at risk,” which I know you covered a bit. I feel like there's a lot to unpack there still. Maybe start first with what you mean by a quadruple aim framework. Can you walk through that section for us, and then would love to hear a little bit more about the various studies that indicate organizations with higher provider burnout produce lower patient experiences, which seems like a pretty important proof point.

05:12
Ryan D
Yeah. Happy to. That's a great observation, Chris. First, regarding your question on the quadruple aim, that's a fairly well-known framework for how to improve healthcare in the United States. It first started as the Triple Aim back in 2007, but it advanced to the quadruple aim in 2017. And what it consists of is, number one, improving the patient experience and healthcare. Number two, improving population health and care outcomes. Number three, lowering the cost of care. And then fourth, improving provider satisfaction, which coincidentally was the fourth leg that was added to the framework in 2017.

The gist of the framework is that if we move to more value-based care delivery, where we're paying for outcomes versus the volume of services delivered, that should really drive better care, lower cost and higher satisfaction from a party.

And that's a framework that healthcare leaders are expected to use in making their care delivery and investment decisions for the future. So that, in effect, hits on your question about what the quadruple aim is. Now, tying this back to our report, other than the obvious factor of provider satisfaction, how does burnout impact the other three legs of the quadruple aim?

Well, as you said, myriad studies indicate that organizations with higher burnout levels do produce lower care outcomes and worse overall patient experiences. And this should be probably fairly obvious to our listeners, no different than thinking about culture and an organization, in my view. So having a good corporate culture or having an engaged team is really key to operationalizing a strategy and driving results in it's really similar in healthcare.

I would say the big difference in healthcare is it literally can be a life-or-death matter for your customer. And data shows that things like medical errors, infections, family complaints and subsequent lawsuits, etc. are all positively correlated with higher burnout rates. So burnout can and does absolutely put a patient at risk.

The other interesting point here is it increases the overall cost in that system. In fact, studies we reference in the report indicate the cost could be as high as $5 billion to $9 billion a year, with the drivers being things like reduced capacity, the need to recruit and replace lost providers, lost revenue due to those capacity constraints and the cost associated with all the training and credentialing and privileging of new staff.

And just to put it to an organizational level, we quote the Annals of Internal Medicine. They did a study that indicated that the annual cost related to burnout or turnover and reduced workflows is about $8,000 per employee physician per year for hospitals. So that's a huge cost. And again, that's on top of the potential cost for medical errors and needs for treatment and lawsuit and healthcare waste.

And then one last point I think is also important. We already know there's a provider shortage and long wait times to obtain care and many markets. So you take me on a personal front as an example, I had a cardiac issue that I became aware of the first week in January after I did our executive physical, and I was literally just able to schedule a test and see a cardiologist a few weeks ago.

Now, luckily, everything was fine, but it literally took me nearly six months to get a test and a visit, which is crazy. And if burnout increases and then you add on top of that an aging population and more chronic care needs, it's not going to get any better. So we truly need to stop this from occurring, or access to care and outcomes and satisfaction with healthcare are all going to get worse. So it certainly shows why the surgeon general said this could become a public healthcare crisis.

08:40
Chris T
So what is it exactly that's driving this provider burnout? I know in the report you mentioned there's a number of root causes, but what are the most prevalent and then how are they interconnected?

08:49
Ryan D
The data here is really clear. Number one issue by far is having too many bureaucratic tasks, things like charting every patient encounter, an electronic health record. It could be something like doing paperwork, reading medical journals, etc. It's just overwhelming. And providers simply can't keep up. In fact, a recent survey by a large HR vendor indicated that about 91% of providers believe regulatory burdens are increasing.

So, it's clearly a really prevalent issue. There's also a ton of strain from things like prior authorizations, which are required from insurers. And that's when you have to effectively get an okay from an insurer to refer a patient for a procedure or to see a specialist. It just takes unnecessary time and effort. It's wasteful. It's frustrating. You're writing reports to get approvals from a payer, but unfortunately, managed care is using this more and more each year as a tool.

And then, lastly, I would say it becomes a downward spiral at some systems. Meaning if you have burnout and turnover, it becomes self-fulfilling that the environment's going to worsen. So the remaining staff has to take on more work, or they're may be working with new team members that are insufficient. They don't know the processes on their teams. It really just compounds over time so you don't nip it in the bud. Those are some of the key issues. And I would say that the regulatory burden and documentation is by far the largest.

10:05
Chris T
And if anything, the magnitude of this issue just seems to be growing, not shrinking, as you pointed to. It also sounds like there's a grasp on what the drivers are, but is there anything that can be done to address it? Which I think is a good segue into what the potential solution sets and product offerings might be, which you do lay out in the report. But would love to hear that a little bit.

10:25
Ryan D
Yeah, definitely a big piece of the report. And it's definitely a growing issue today, as you said. As I mentioned, I've never seen this level of burnout before. And it's a bit ironic, is one of the big solutions in addressing the burnout caused by technology is with technology. So again, just to set the stage, one of the biggest issues is the need for doctors to input everything they do and see into an electronic health record.

Now, clearly there are benefits to this. We all want to have this data in electronic form, to track the health of patients, to share test results, to allow patients access to the data. But it takes a lot of time, and a lot of what's done is simply for pure documentation and billing purposes. It's not for care. And it's, you know, it's frustrating to sit in exam room with a doctor where all his or her attention is on the computer.

You know, again, I mentioned earlier, I was just with my cardiologist, and he literally just asked me a set of standard questions that he was reading off his screen. He typed directly into the EHR and I'm not sure he even looked at me or really asked me about my concerns until really late in our visit. So, it was not a great experience at all, you know?

That said, he doesn't really have a choice. That's how he needs to operate to make a record, to invoice my insurer, to request future tests and ultimately to get paid. So I get it. But again, it just doesn't create the greatest environment. It was it was a little frustrating. You know, when you go in as a patient you're concerned about your health. You have a medical condition. He's sitting there typing on the HER.

11:48
Chris T
Doesn't feel very caring.

11:49
Ryan D
No, no, not at all. Bedside manner is not that great with the EHR. But one area to kind of go into and you reference what the solutions are. We're seeing a huge wave of investment, things like ambient documentation tools and artificial intelligence that help auto populate these medical records. So, to go a bit deeper here, this would be if you go into the provider office to revisit, and the provider uses a software solution that effectively listens to the conversation you have ambiently, so in the background, and then it auto populates the record using large language models and AI. So, the doctor here can actually move away from the keyboard and interact with the patient. And then the tool captures all of that, puts the data in the right sections of the air, and when the patient leaves, the doctor just needs to look at the record, make any corrections, and sign off on it.

So again, he or she is actually engaged with the patient, which is what both parties really want during a visit. And then afterwards. It's very simple to review and approve. And this has been shown to save literally 18 to 20 hours a week. For many doctors. It's huge trend, huge time saver.

And there's a lot of capital flowing into the market. And if you think about something as simple as this one solution, the time that is saved can either be used to see more patients or simply for the provider to recapture his or her free time. So, either way, it's it's really a win win.

You know, a couple more things. We're starting to see AI impact things like provider inbox management as well. This is really interesting. We have this in the report because data indicates that after the pandemic, which caused a lot more virtual care and electronic communications between patients and their providers, doctors saw about a 160% increase in things like patient portal messages. So again, it's just another one of these burdens outside of actually seeing a patient that's taking up more time than it did just three or four years ago.

So, if there's a solution to triage these inbound communications in order to send them to others, it can be a major time saver. As an example here, if it's something like a simple prescription refill request that comes in, that can automatically go to a centralized provider to address all these issues and keep the email or mailbox burden down.

Now for the doctor, that's a win again. But for the patient, it's a win, too, because that request might sit there in the inbox for hours or for days. So, the common theme here, a win win solution again. As I mentioned before, prior authorization is another big issue. Well, what we're seeing is with ChatGPT, it's pretty easy to tell the tool to write one of these prior authorizations for a patient.

So you can say, I have a patient with condition XYZ, I want this specific test and I want it written for this insurance company's prior authorization. It will auto populate it. And then I can send that right off to a payer. So again, using AI and ChatGPT are probably going to be a huge areas in our view, really to help address the administrative burdens that cause a ton of the burnout issues. You know, the provider wins with less burden and the patient gets quicker approval for care delivery. So again, a win win.

You know, lastly, I guess I'd also make the point. This is really not from a technology perspective. But we believe the growth in all these advanced primary care practices is going to help as well. These are practices that get paid to manage the full cost of care for patients. So, the providers get recurring monthly fees, and they're on the hook for all the cost of care. And they tend to have markedly smaller patient panels. And that allows them to spend more time actually working with patients to understand and address issues, which is proven to be much more rewarding from a work environment standpoint. It drives better care and outcomes and increases patient satisfaction, especially for seniors.

So again, you think of that quadruple aim, this novel business model where giving providers all the financial risk and responsibility, but also the time to care for their patients, really achieves that quadruple aim. It increases shifts faction, increases outcomes, lowers the cost of care, and increases the provider experience. So, you know, a huge trend we see in the space and one that is shown to reduce burnout as well.

You know, frankly, I could go on and on about potential technology solutions or model changes or regulatory changes, but I'll leave the rest of the report in the interest of time.

15:57
Chris T
Yeah. You know, the report is long but very interesting. And for those interested in reading the rest of the report, you can either contact us at our William Blair Contact Us page or your William Blair representative. Ryan, this has been great. Is there anything else before we jump off that you wanted to mention?

16:13
Ryan D
No, I think we covered a lot of ground today. I would just add, you know, we do profile a lot of the areas we see as benefiting and the key operators in each subsegment in the report you just mentioned. So again, if anyone is interested in a deeper dive into the topic or learning more about the leading tech or services companies in the space, I would definitely recommend taking a look at the piece. We also have some sections that show funding activity in certain sectors, etc. so again, just as a good reference for any listener who's interested in the report. And I'll also use this just as a plug for the past reports. Again, we have a bevy of these and things like advanced primary care, specialty care, social determinants of health, food as medicine, etc.. So not just this piece, but there's a lot out there for our listeners that that they may have interest in.

16:54
Chris T
There is and also podcast episodes on the same thing. So as always, appreciate you stopping by. Thanks again. Let's do it again soon. And I'm assuming we'll probably do this the next mosaic.

17:03
Ryan D
Every quarter. So look forward to it and hope everyone has a great week. Thanks so much for your time Chris. I enjoyed doing this.