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Physician Burnout Much Lower in Small Practices, Research Finds

July 9, 2018
by Rajiv Leventhal
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Physicians who work in small, independent primary care practices reported dramatically lower levels of burnout than the national average (13.5 percent versus 54.4 percent), according to a study led by researchers at NYU School of Medicine.

The research, published online July 9 in the Journal of the American Board of Family Medicine, examined data collected from 235 physicians practicing in 174 small, independent practices in New York City. The findings, according to researchers, indicated that the independence and sense of autonomy that providers have in these small practices may provide some protection against symptoms of burnout. 

Physician burnout has been ramped up as a major concern for the healthcare industry of late. It is associated with low job satisfaction, reduced productivity among physicians, and may negatively impact quality of care. Multiple national surveys suggest that more than half of all physicians report symptoms of burnout. 

What’s more, from a technology standpoint, reducing the burden that IT puts on doctors is a key priority for ONC (the Office of the National Coordinator for Health IT) right now. In fact, the health IT agency hired John Fleming, M.D., deputy assistant secretary for health technology reform at ONC, last year, with one of his core responsibilities being to reduce provider burden.

To date though, most research on physician burnout has focused primarily on hospital settings or large primary care practices. The researchers of the NYU School of Medicine attested that this is the first study that examines the prevalence of burnout among physicians in small independent primary practices—practices with five or fewer physicians. Despite declines in the number of small practices in the U.S., primarily due to market forces driving consolidation, close to 70 percent of all primary care office visits occur in small practice settings, according to the American Medical Association (AMA).

The survey revealed that the rate of provider reported burnout was 13.5 percent, compared to the 2014 national rate of 54.4 percent. A 2013 meta-analysis of physician surveys conducted in the U.S. and Europe found that lower burnout rates were associated with greater perceived autonomy, a quality and safety culture at work, effective coping skills, and less work-life conflict.  

For the survey, researchers analyzed data as part of the HealthyHearts NYC (HHNYC) trial, which is funded by the Agency for Healthcare Research and Quality’s (AHRQ) EvidenceNOW national initiative. The HHNYC trial evaluates how practice coaching or facilitation helps small, independent practices adopt clinical guidelines for the treatment and prevention of cardiovascular disease.

Each physician answered a multiple choice question with response options indicating various levels of burnout. Options ranged from no symptoms of burnout, to feeling completely burned out and questioning whether or not to continue practicing medicine. The question was validated against the Maslach Burnout Inventory, a nationally recognized measure that identifies occupational burnout. Physician respondents were categorized as burned out if they checked one of the last three options in the multiple choice question.

As part of the HHNYC trial, physician respondents were also asked a number of questions about the culture of their practices. The tool used specifically measures “adaptive reserve,” or a culture where individuals have opportunities for growth, and the ability to learn from mistakes by talking and listening to each. Physicians that described this kind of culture in their practice reported lower levels of burnout, researchers said.

“Burnout is about the practice culture and infrastructure in which primary care doctors work. So the obvious question is: what is it about the work environment that results in low burnout rates in small practices?” said Donna Shelley, M.D., professor of Population Health and Medicine at NYU School of Medicine, and the study’s senior author. “It’s important to study the group that’s NOT showing high burnout to help us create environments that foster lower burnout rates. The good news is that a culture and systems can be changed to support primary care doctors in a way that would reduce the factors that are leading to burnout.”     

Shelley noted that folks should be careful not to minimize the challenges that physicians working in solo or small practices face. She cites that even though burnout rates are lower, many of these practices are struggling financially, and many of these physicians are on call all the time. 

“The more we can understand what drives low rates of burnout, the more likely it is that we’ll find solutions to this problem,” said Shelley. “The hope is that our research can inform ways for larger systems to foster autonomy within practices so that there is space to carve out a work environment that is aligned with doctors’ needs, values and competencies.” 

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Why A.I. Will Never Replace Recruiters

September 12, 2018
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AI can be a great tool, but recruiters aren’t going away

I remember fear settling in like a big dark cloud when I opened my search practice in 2005 with all the dire predictions of how the Internet and all the online hiring websites were going to put recruiters out of business. Many articles were written on the demise of the recruiter as Monster.com would literally scare us out of business.

Then came other job opening aggregators like Indeed.com, ZipRecruiter and a whole host of other websites chasing HR gold as if there was a switch they could simply flip to eliminate the human touch that recruiters bring to the table with engaging candidates, only to be replaced by a text message alert or an email notification of all the new jobs that were now open. The only thing they were missing were qualified applicants.

These predictions never came true and all the prognosticators simply forgot what recruiters actually do every day that their technologies will never replace. CIOs need to remember the critical nature of hiring leaders and team members for key roles in their organization. Candidates need to be vetted and coached to listen to an opportunity to join your team when we call the candidates. You have to remember:

  • We talk with people. Yes, we use a cell phone, or now a VOIP phone, and actually engage in a dialogue with candidates about opportunities. It’s a novel approach—I get it.
  • We engage with people that will never look on those job posting sites because they are not looking for a new job. Period.
  • We contact passive candidates that up until our call were never going to leave their job because they are so focused on the now that they don’t even think about looking on a website for a job they are not even interested in.
  • We help clients and candidates come together on the right offer and provide two-way communication during the hiring process, so each party has a deep understanding of the other party’s point of view. Online sites—well you get the picture…
  • We hammer out the details of relocation packages with our clients and the candidates and their families to make sure the move is done smoothly to allow the family to begin their transition to a new city. It’s the personal touch that matters here because we are dealing with people’s lives.

Fast forward: The next wave of artificial intelligence (AI) products for hiring are cropping up everywhere and we are hearing similar calls for recruiters to give up and retreat as the latest algorithm and data analytics tools are able to speed up the hiring process supplanting recruiters. Within seconds, these tools are touting they can determine who the perfect candidates are based on the analytics and machine learning tools designed for hiring. Guess what? It won’t happen.

AI can be a great tool, but it falls dreadfully short of meeting hiring managers' expectations. It won’t wave a magic wand suddenly making hiring enjoyable and much quicker with the same quality as the work performed by most search firms. I’ve been in technology in some form or fashion for a very long time. I love technology and what technology can do to speed up productivity and actionable data I can use every day in the work we do. It’s awesome!

But to be clear, I’m not going away. I have seen this movie before and I am fairly certain I can tell you how it ends. The work recruiters do to find and recruit great talent is something humans must do.

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Cerner President Zane Burke to Step Down This Fall

September 10, 2018
by Heather Landi, Associate Editor
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Cerner president Zane Burke, who first joined the company in 1996, will step down November2, the Kansas City, Mo-based electronic health record (EHR) company announced today.

“Cerner has been a disruptive force of positive change across health care throughout its history, and I’m pleased with the accomplishments we’ve achieved together with our clients and the broader industry community,” Burke said in a statement. “Complex and evolving challenges remain, and Cerner is uniquely positioned to continue innovating for the good of consumers and health care providers.”

 “We thank Zane for his contributions to Cerner across more than two decades,” Cerner Chairman and CEO Brent Shafer said in a statement. “Zane leaves the company with a strong client focus and commitment to continued innovation, partnership and sustainable growth deeply engrained in our culture and leadership philosophy. I am very confident in the capabilities of Cerner’s strong and experienced leadership team.”

John Peterzalek, executive vice president of worldwide client relationships, will assume Burke’s responsibilities and the title of Chief Client Officer.

Since joining Cerner in 1996, Burke had a range of executive positions across sales, implementation, support and finance. He was named President in 2013 after leading Cerner’s client organization. Burke came to Cerner in 1996 from the consultant KPMG, and has held a number of positions in the company, including president of Cerner west from 2003 to 2011, and, more recently, executive vice president of Cerner's client organization.

During his five years as president, Burke has been involved in a number of significant deals, including playing an instrumental role in Cerner winning two massive EHR modernization contracts, first with the U.S. Department of Defense (DoD) in 2015, a $4.3 billion contract, and then just this past May, with the U.S. Department of Veterans Affairs (VA) in a $10 billion contract.

During Burke’s tenure, Cerner also completed one of the biggest deals in healthcare IT history with the acquisition of Siemens healthcare IT business for $1.3 billion in 2014.

The Kansas City Business Journal reported on September 4 that Burke had exercised option to sell nearly $10 million in stock.

 

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Leadership Changes at HHS as CIO Transferred to New Role

August 21, 2018
by Heather Landi, Associate Editor
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Beth Killoran is stepping out of the role of CIO at the U.S. Department of Health and Human Services (HHS) and is moving over to a new role at the Office of the Surgeon General, within HHS.

The news was first reported by Federal News Radio. In an email, a HHS official confirmed that Killoran, who stepped up to the HHS CIO role in July 2016, has joined the Office of the Surgeon General at HHS to develop a "comprehensive information systems strategic plan for the U.S. Public Health Service Commissioned Corps.”

The HHS official also confirmed that Ed Simcox, the HHS Chief Technology Officer, will take on the added role of serving as the HHS Acting CIO, until a permanent selection is made. “Simcox has led multiple, large IT transformation efforts, both as an industry executive and consultant. As HHS’s CTO, he leads HHS’s efforts on enterprise data management, data sharing, technology-related healthcare innovation, and public-private partnerships,” the official said via email.

Simcox started as the HHS CTO in July after serving as acting CTO starting in May and deputy CTO since July 2017, according to Federal News Radio.

Killoran began working at HHS in October 2014, moving over from the Department of Homeland Security. At HHS, she has served as the acting Deputy Chief Information Officer and as the Executive Director for the Office of IT Strategy, Policy and Governance. The HHS official stated that Killoran has served in a number of high-level information technology positions at HHS, “providing leadership on a number of high priority projects.” Killoran also worked for the Department of the Treasury, where she provided IT infrastructure support and operations for over 20,000 employees across 1,500 locations.  During her tenure, she provided IT operational support in response to the 9/11 and Oklahoma City bombing events, the HHS official said.

Federal News Radio reporter Jason Miller reported that, during her time as HHS CIO, Killoran tried to move the agency forward in a number of areas through an updated strategic plan and a more aggressive approach to cloud adoption. “Recently, Killoran led a reorganization of the CIO’s office, naming Todd Simpson as the first chief product officer and promoting innovation,” Miller wrote.

Killoran becomes the fourth major agency CIO to be reassigned during the Trump administration, joining former Treasury Department CIO Sonny Bhagowalia, former Agriculture Department CIO Jonathan Alboum and FEMA CIO Adrian Gardner, according to Federal News Radio’s reporting.

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