A recent retrospective cohort study published in JAMA Network Open asks the question, “Can vendor-derived electronic health record (EHR) use data platforms be used to understand and explain physician turnover?” With physician turnover taking a heavy toll on patients, physicians, and healthcare organizations, the research established associations of EHR use with professional burnout and reduction in professional effort, although with some notable caveats.
The study included more than 300 physicians at a nonteaching large ambulatory practice network based in New England, with data collected from March 2018 to February 2020. Examining more than 5600 physician-months of data revealed the following:
- A turnover rate of 5.1% per year (32 of 314 physicians)
- Physicians had a mean of 2.6 appointments per hour (95% confidence interval [CI], 2.5-2.6 appointments/hours) and 206 appointments per month (95% CI, 197-215 appointments/month)
- 5 hours (95% CI, 5.3-5.8 hours) of EHR time was spent for every 8 hours of scheduled patient time
- Several variables were associated with turnover after controlling for sex (39% of participants were women), medical specialty, and time, including:
- Inbox time (odds ratio [OR], 0.70; 95% CI, 0.61-0.82; P < .001)
- Teamwork (OR, 0.68; 95% CI, 0.52-0.87; P = .003)
- Demand (ie, proportion of available appointments filled: OR, 0.49; 95% CI, 0.35-0.70; P < .001)
- Age 45 to 54 years (32% of physicians were in this age group) vs 25 to 34 years (OR, 0.19; 95% CI, 0.04-0.93; P = .04).
According to a quote by one of the study’s authors and AMA vice president of professional satisfaction, Christine A. Sinsky, MD, the thought was that by looking at time on the EHR and time on the inbox and work outside of one’s scheduled work hours, there would be some predictors that a practice could use. It was discovered, however, that lower EHR use by a physician was also associated with a higher chance of departure.
In summary, physician productivity and EHR use metrics were directly associated with physician departure. Through a prospective tracking of these metrics, it is believed that physicians at high risk of departure could be identified and would benefit from early, team-based, and targeted interventions. It was concluded, however, that the counterintuitive finding of physician departures being associated with less time spent on EHR tasks, and, in particular, inbox management, warranted further investigation.
