Study: Physician Turnover Linked to Higher EHR Proficiency

Key Insights

• Physician turnover can cost independent practices several thousands of dollars in recruitment, onboarding, and training costs.
• A new study shows that, counterintuitively, physicians with higher EHR proficiency are more likely to leave their practices.
• Independent practice owners or managers can help reduce physician turnover by building a high-performing team and keeping patient volume steady.

Background

It’s no surprise that physicians who are dissatisfied with their electronic health records (EHR) are more likely to leave the practice. Studies show that 53 percent of practicing physicians are either dissatisfied or very dissatisfied with their work-life balance, and 85 percent point to their EHR as the reason.

Several cross-sectional studies have found that there is a relationship between “professional satisfaction, burnout, intention to leave, and actual reduction in physician effort” at the office. These studies directly associate a physician’s after-hours EHR use with burnout and dissatisfaction with work-life balance.

The ramifications of EHR use are serious. Physician burnout can lead to turnover, which is an expensive problem. When accounting for the time spent away from patients interviewing candidates, onboarding, and training, recruiting a new physician in a healthcare organization can cost “as much as $1 million per physician departure.”

Even worse, physician turnover leaves less medical resources for the general population. Studies forecast that physician burnout may lead to a “projected shortfall of 35,000 to 90,000 physicians by 2025.” The lack of primary care physicians can drive up healthcare costs and lead to worse patient outcomes.

While studies show there is a correlation between high EHR utilization and physician turnover, an emerging study shows that there may also be a correlation between a physician’s proficiency with their EHR and physician departure.

Physician Turnover Linked to High EHR Proficiency

A study published in the Journal of the American Medical Association (JAMA) found that, “counterintuitively, less time spent on the EHR (in particular inbox management)” can show a higher likelihood of physician departure. The retrospective cohort study examined “ambulatory physicians’ turnover across an ambulatory care delivery network over a two-year period” and to determine how their EHR use may have contributed to their departure from their practices.

The study identified and used “the five core EHR use metrics,” including: the physician’s total EHR time, work outside of scheduled clinical hours, encounter note documentation time, and time spent on inbox, all of which were “normalized to eight hours of scheduled patient time.” The study also used “teamwork on order” to measure team engagement and its link to physician turnover.

The study found that, overall, “low demand for a physician’s service,” “inbox time,” and “rates of teamwork on orders” were key to identifying physicians who were at risk of departing. Overall, physicians with higher proficiency in their EHRs did not spend as much time on it. Researchers believe that physicians with lower EHR utilization have become “proficient with the EHR,” which makes them “more marketable to move to a new position” at another practice.

Not all proficient EHR users will eventually leave their practices, but physicians with more experience are more likely to leave if a practice offers them a better work-life balance, higher compensation, or a stronger team. Evidence shows that physicians who practice in “a productivity-based compensation network” who have “consistently low patient volumes may choose to leave the network because of lower than expected income.”

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