ReviewEnhancing practice efficiency: A key organizational strategy to improve professional fulfillment in allergy and immunology
Introduction
Professional burnout is prevalent among US physicians, including allergists-immunologists, at rates substantially higher than the general working population.1,2 Recent limited surveys suggest at least 35% of US allergists-immunologists report symptoms of burnout.3, 4, 5 Burnout is defined as a work-related reversible syndrome characterized by emotional exhaustion, depersonalization, and a low sense of personal accomplishment. Burnout can overlap with other features of physician distress, such as fatigue, stress, depressive symptoms, moral distress, and dissatisfaction with work-life integration.
The impact of burnout on clinicians, patients, and health care systems is profound.6 At the individual level, there is a moral and ethical imperative to address burnout as it is associated with an increased risk of broken relationships, alcohol and substance use, depression, and suicide. Burnout also threatens key patient outcomes, including quality and safety of patient care, with an increased risk of medical errors and decreased patient satisfaction. For health care organizations, burnout is costly, as it poses challenges to the retention and recruitment of physicians and patients.7
Given the current prevalence and impact of allergic and immunologic disorders, it is imperative to address burnout among allergists-immunologists. But how do we get there? What are the most effective strategies to go beyond merely eliminating burnout to helping allergy-immunology clinicians achieve true professional fulfillment? To develop effective strategies, the drivers of burnout must first be understood. Inefficient, chaotic, and administratively burdensome work environments have been recognized as a key predictor of clinician burnout.8 For allergists-immunologists, efforts to improve workplace efficiency may be particularly beneficial in rapidly and directly improving professional well-being. This review discusses evidence-based organizational strategies that have been found to enhance practice efficiency and thereby reduce burnout and improve professional fulfillment.
Section snippets
What Drives Professional Fulfillment?
A growing body of evidence indicates that strategies to address burnout must intervene on a wide array of drivers, addressing both individual clinicians and the systems and culture of their surrounding work and practice environment. The Stanford WellMD model recognizes the following 3 reciprocal domains that directly drive physician fulfillment: personal resilience, a culture of wellness, and efficiency of the practice (Fig 1).9
The model’s first domain, personal resilience, relates to factors
Proven Strategies to Enhance Practice Efficiency
There are several evidence-based tactics to improve practice efficiency, which may be particularly relevant to allergy-immunology. Strategies to improve documentation burden, team-based care, and inefficient workflows will be discussed below.
Reciprocal Effects of Enhanced Efficiency on Resilience and Culture
The strategies discussed above to enhance practice efficiency have reciprocal effects on the other domains in the Stanford well-being model (Fig 1).9 Efforts to improve the efficiency of clinical environments often result in a shift in culture, for example, a greater sense of teamwork and stronger value alignment with leadership. Similarly, measures to increase the efficiency of practice lead to time savings for physicians, which may allow them the opportunity to engage in self-care and
Conclusion
Professional burnout is prevalent among physicians, including allergists-immunologists, and threatens the safety and quality of patient care they provide. Much of this burnout is driven by administrative burdens and inefficiencies. Evidence-based, organizational strategies can create a more efficient practice environment by reducing administrative and clinical documentation burden, fostering models of team-based care, and encouraging physicians to engage in a clinical redesign. We must also
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Disclosures: The author has no conflicts of interest to report.
Funding: The author reports receiving funding as a coinvestigator from the National Institute of Allergy and Infectious Diseases (R01 AI130348-01A1), Aimmune Therapeutics, DBV Technologies, and Regeneron Pharmaceuticals, Inc.