THE ISSUE
Physician burnout, a condition in which physicians experience a diminished sense of satisfaction and efficacy in their work, has become widespread in medicine, driven by rapid changes in health care and the professional environment. This phenomenon existed
long before COVID-19 and has only been exacerbated by the pandemic. There are a multitude of factors contributing to physician burnout, including increased administrative burden; workforce shortages; and sexism, racism, and discrimination in the workplace.
Escalating practice costs are also a key stressor, including labor costs and historic inflation, which are compounded by the financial instability caused by low reimbursement for patients who are insured through MassHealth and continuous threats of
Medicare payment reductions for physician practices. These factors collectively undermine practice stability and sustainability and thus have negative implications for patient access to care. Further, the inability of physicians to act in the best
interest of their patients due to lack of resources, administrative complexity, or other barriers is known as “moral injury.” This moral injury undermines the physician's work and their ability to care for their patients as they would prefer. On top
of this collective burnout, stigma and barriers to support and recovery persist, as physicians fear losing their license and credentials because of overly broad and invasive mental health questions on applications that are stigmatizing and discriminatory.
OUR STANCE
The current situation is inherently unsustainable. While there is no single solution to physician burnout, the Massachusetts Medical
Society seeks common-sense reforms to reduce stress on physicians and improve and increase support for physicians. These reforms focus on improving physician well-being by reducing administrative burdens, including prior authorizations, reducing state
and federal regulatory requirements, providing adequate staffing, addressing sexism and racism in the workplace, improving EHR processes, and promoting organizational and institutional cultures of support and well-being, including reducing stigma
to seek care and allowing flexibility in schedules.
OUR ADVOCACY
The MMS survey “Supporting MMS Physicians’ Well-being Survey and Report”
has provided invaluable data quantifying and substantiating the challenges physicians are facing in the workplace. This survey report highlights important disparities by both gender and race, as well as variability by practice environments and by
years of practice. These findings are in general agreement with recent national data from the Physicians Foundation on physician burnout[1].
The MMS also spearheaded the Joint Task Force on Physician Burnout. In 2018, the MMS and Massachusetts Health & Hospital Association (MHA) formed a joint task force to address physician burnout. The mission of the joint task force was to identify and
prioritize effective strategies to mitigate burnout and to advocate for statewide adoption of identified strategies and practices, as detailed in the report, A Crisis in Health Care: A Call to Action on Physician Burnout.
In the 2023–24 legislative session, the MMS has been successful in advocating for expanding reporting exemptions to the Board of Registration in Medicine for physicians who are in an approved program for mental health treatment; for example, physicians
accessing mental health treatment through an agreement with Physician Health Services (PHS) will now be protected for mandatory reporting to the Board. Additionally, a key legislative
priority for the MMS this legislative session is An Act to improve
the health insurance prior authorization process (H.1143) and An Act relative to reducing administrative burden (S.1249), filed by Representative Santiago and Senator Friedman, respectively. The identical legislation proposes comprehensive
prior authorization reforms that will reduce administrative burden in the health care system and promote access to quality, timely care.
Importantly, for the past three years, the MMS, working with MHA and PHS, has successfully advocated for the removal of overly broad and intrusive mental health questions for physician licensure, as well as hospital,
health plan, and malpractice credentialing applications. These changes aim to reduce stigma and encourage those in need to seek mental health care.
- For example, the BORIM licensure application contains a question seeking to learn about “medical or physical conditions that may impact your practice of medicine.” Previously, this question was open-ended and looked to the past for any condition,
but is now limited to whether an applicant has a condition that currently impairs their ability to practice medicine. A similar change was made to a question about the utilization of chemical substances that may impair your ability to practice
medicine.
- As for hospital and health plan credentialing improvements, the MMS and MHA have been successful in eliminating the original “question 20” on the Integrated Massachusetts Application for Initial Credentialing, which read, “Have you engaged in the
illegal use of drugs within the past ten years?” Now, the remaining question asks whether the clinician is currently engaged in illegal drug use.
- The MMS, MHA, BCBSMA, PHS, and the AMA have successfully advocated for the accrediting body of health plans, the National Committee for Quality Assurance (NCQA), to limit their health plans intrusive questions due to our collective work. NCQA requires practitioners to attest to their lack of present illegal drug use, but not to past drug use or history of drug use.
Additional resources are available:
[1] https://physiciansfoundation.org/research/amplifying-physician-resident-and-student-voices-to-drive-wellbeing-and-care-delivery-solutions/
