Jun 28, 2019

Let Surgeons Do Surgery

Davis Warnell Program Associate , Andrea O'Sullivan Feature Writer

American healthcare providers are facing a care crisis of their own: they’re burned out. Whether it’s due to paperwork, administrative tasks, or merely the burden of explaining health concepts to patients between bureaucratic exercises, too many physicians find themselves stretched too thin. 

What can be done to alleviate this very real problem?

This is no small issue. Of more than 15,000 physicians surveyed across 29 different specialties, 44 percent reported they felt burned out, a term commonly used to describe feelings of exhaustion or lack of motivation. Of those physicians, 59 percent attributed their burnout to bureaucratic and administrative tasks. The vast majority—73 percent—spend up to 14 hours weekly on paperwork and other administrative tasks.

Three months ago, one of us had an accident that gave him an opportunity to witness the systemic inefficiencies that are wearing down our physicians. After being rushed to the emergency room, Davis was diagnosed with a fracture of both the tibia and fibula bones, as well a closed dislocation and fracture of the ankle. The subsequent weeks involved multiple clinical visits, surgery implanting 20 screws and two plates to fix the bones in place, and a strictly regimented physical therapy schedule.

While his surgeon was filling out paper work, reading x-rays, and rushing through clinical visits, he understandably appeared irritated, impatient, and rushed. This was not an ideal situation for clearly communicating important care and recovery information. Unfortunately, 56 percent of physicians report they spend 16 minutes or less with each patient. Both physicians and patients have complained about such short visits.

On the day of surgery, Davis saw a completely different demeanor. The same surgeon, doing what surgeons are trained to do, looked eager to take him to the operating room and begin surgery. Davis began to wonder if these mundane office tasks were taking a toll on his surgeon by adding to his already-considerable workload.

Physician burnout can have a number of deleterious effects on the healthcare system. For the patient, physician burnout invites declining quality of care, an almost doubled risk of medical errors, longer recovery periods, and lower patient satisfaction. On the healthcare system as a whole, burnout can reduce physician productivity, increase turnover of physicians, decrease patient access to the physician, and increase costs. When it comes to the physicians themselves, burnout can lead to substance abuse, symptoms of depression, and poor self-care.

There is a solution: allow qualified non-physician providers to lighten the load. Depending on the scope of practice laws in a given state, physician assistants (PAs) can be authorized to perform most of the above-mentioned functions. To start with, a PA’s practice authority often already includes diagnosing and treating illnesses. For example, in some states, a surgical PA can do most pre- and post-surgery visits, read and explain x-rays, and construct treatment and recovery programs with the patient, just as Davis’s surgeon did.

After a PA performs these functions, he or she would be able to assist the primary physician with those bureaucratic and administrative tasks that so heavily burden physicians. In a study published in the British Medical Journal, researchers found that consultations with nurse practitioners (NPs, another class of non-physician provider) actually increased patient satisfaction more than those with doctors.

There are some possibilities to consider. Physician’s assistants do not generally have the same time constraints as physicians. This opens up the door for longer visits and more face-to-face patient/provider interactions. The extra quality time with the patient can increase patient satisfaction, and frees up time for the physicians themselves. The added schedule flexibility of PAs also allows for same-day visits, something that is not very likely with a busy physician.

Some might be reluctant to reduce personal interactions with their surgeons, but a surgical PA is considered a surgeon’s first assistant during the actual surgery. They are actually in the operating room assisting with all that the surgeon is doing. If they were also in charge of all pre-surgical and post-operation visits, there would only need to be a quick briefing for the surgeon himself before performing a standard surgery, and the surgeon would only need to be consulted if complications arose after the surgery. Delegating tasks like these opens up the physician’s time and potentially reduces burnout associated with mundane tasks.

Reforms could also add prescriptive authority a PA’s scope of practice. (Pharmacology training is part of the general education requirements for PAs.) In 39 states, physician’s assistants are legally given prescriptive rights, the scope of which is determined on-site by their supervising physicians. In other states, the extent of this privilege is regulated at the state level. Expanding PAs’ prescriptive authorities is yet another way to lessen the time constraints on physicians. 

Overall, in the healthcare industry, we underutilize a wide range of non-physician providers, including physician assistants, nurse practitioners, and nurses themselves. Not allowing these professionals to practice up to the full authority of their training not only places time constraints on physicians, it also increases the costs absorbed by the insurance providers, taxpayers, and patients themselves. Reducing physician burnout could have a significant impact on the efficiency of the healthcare community. Allowing PA’s, NP’s, and nurses to practice under their full authority is a good start. 

Photo credit: Romain Lafabregue/Getty Images

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