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“Burnout is an occupational condition, right? So, to try and treat burnout like a mental health condition and tell us, ‘Okay, something’s wrong with you, just go seek mental health care’ is just not enough. There’s this whole bucket of work where we really need to be supported when we have mental health issues, but it’s not enough just to have this 24/7 hotline. You actually need to help us stay well while we’re on the job.”

Dr. Tina Shah

A lot of things have happened in healthcare over the last decade that have made it one of the hardest times ever to practice medicine in a sustainable way without burning out. This drove Dr. Tina Shah and some of her colleagues to come together to create actionable steps that healthcare organizations can take now to do their part to reduce physician burnout. In this episode, cohost and Lead Coach Jill Farmer speaks with Dr. Tina Shah about these actionable steps, and what drives Dr. Shah’s work on burnout in healthcare.

Dr. Tina Shah is a pulmonary and critical care physician with over ten years of experience in clinical burnout, health policy, and digital health. She recently served as senior advisor to the U.S. Surgeon General, where she was the chief architect of the nation’s first strategy to address burnout and the great resignation among health workers. She’s also served in the White House over two presidential administrations and, as an operator during the pandemic, oversaw the launch of telemedicine across a large health care system. Dr. Shah also now advises health systems and technology companies on how to redesign care for better outcomes while continuing to practice on the front lines in the ICU. She’s a founding member of the National Academy of Medicine’s Clinician Wellbeing Collaborative and recently hosted the country’s premier conference on clinician burnout.

Although she did well in residency in terms of well-being, Dr. Shah reached a point during her pulmonary critical care fellowship that made her feel that she couldn’t go any further. This is a relatable feeling for many in medicine. 

Dr. Shah developed what she calls a top five hit list of recommendations to help combat physician burnout and we dive into them in detail. Adjusting expectations is fundamental, and the pandemic has forced the field to practice medicine in a completely different way, with different pressures attached. Improving documentation and technology is also key to making physicians’ jobs easier and decreasing the administrative burden. We talk about the concept of GROSS (getting rid of stupid stuff) and how it can improve physician satisfaction as well as radically rethinking staffing and scheduling. A healthcare facility’s EAP (employee assistance program) is simply not enough to combat physician burnout, and Dr. Shah’s advocacy is exactly what we need.

What’s Inside:

  • Dr. Shah’s journey and what inspired her to become an advocate for physician well-being.
  • The top five recommendations to combat burnout and enhance medical professional well-being on the job.
  • How technological enhancements can prevent physician stress and overwhelm.


Mentioned In This Episode:

DocWorking.com
ALL IN: WellBeing First for Healthcare
Surgeon General’s Advisory on Health Worker Burnout

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Please enjoy the full transcript below

 

Dr. Shah: Burnout is an occupational condition, right?  So to try and treat burnout like a mental health condition and tell us, okay, something’s wrong with you, just go seek mental health care is just not enough. There’s this whole bucket of work where we really need to be supported. Yes, when we have mental health issues. But it’s not enough just to have this 24/7 hotline. You actually need to help us stay well, while we’re on the job, both for mental health, when we think about depression, when we think about suicide, when we think about anxiety, the moral distress we have when we see patients that we know we could have helped, but we just couldn’t because we didn’t have the resources. But then also all the factors for burnout.

Jill: Hello and welcome to DocWorking: The Whole Physician Podcast. I’m Jill Farmer, a co-host of the podcast and lead coach at DocWorking as always or brought to you by DocWorking THRIVE. Go to DocWorking.com today to take our burnout quiz and learn how you can thrive in work and life as a physician or health care professional. We are in for a wonderful conversation today. I am very excited to be joined by Dr. Tina Shah. She is a pulmonary and critical care physician with over ten years experience in clinical burnout, health policy and digital health. She recently served as senior advisor to the U.S. Surgeon General, where she was chief architect of the nation’s first strategy to address burnout and the great resignation among health workers. She’s also served on the White House and VA over two presidential administrations and, as an operator during the pandemic, oversaw the launch of telemedicine across a large health care system. Dr. Shah also now advises health systems and technology companies on how to redesign care for better outcomes while continuing to practice on the front lines as an ICU. She’s a founding member of the National Academy of Medicine’s Clinician Wellbeing Collaborative and recently hosted the country’s premier conference on clinician burnout. And that’s where I had a chance to talk to you and listen to you talk on this subject. And I really thought our listeners on the podcast would get a lot out of what you have to say as well. So thanks for joining us so much, Dr. Shah. 

Dr. Shah: Thank you so much, Jill. And I’m just really excited to be able to talk with you and everyone that listens in today. 

Jill: So before we get down into some, what I like to call, practical tactical ideas that people can walk away. I want to talk a little bit about why you are passionate about physician burnout and why you sort of agreed to take on the extra job of working with the surgeon general to bring this issue into the forefront over the last few years. 

Dr. Shah: So my story really starts in fellowship, and to give some more context, I feel like I in essence, skated by in residency. Your intern year is supposed to be your hardest year. You are the lowest woman or man on the totem pole. But somehow, I did well in residency, at least as far as a well-being standpoint. And really, once I started my pulmonary critical care fellowship, at some point in that first year, I started thinking, I can’t do this anymore, what’s my out? And I know many physicians listening in and others listening in have probably had this feeling before. And they have to, right? Because more than 50% of us are burned out present day. And I started thinking, what the heck can I do? I feel stuck. My skill set seems to be really only conducive to working as a physician. What do I do? And I just never want anyone else to have this feeling. I think we enter the profession for good reasons. Caring for someone and being able to help them achieve health and come out of a sickness is just an honor and something that fills a soul and we need to be able to go back to that. So I really am doing this fueled by my own story. And thankfully I was able to find a way to stay in health care. And part of that is doing this work of trying to ensure my colleagues never feel this way and never get to that extent of burnout or really can be thriving. That’s why I’m here today. 

Jill:  Excellent. And of course, a big portion of the work we do is helping to equip individual physicians with the best tools that they have internally, even when they’ve been often brought up through a system that tries to get them to dis-identify from their own needs. We try to get them to re-identify with what those needs are, because we know when you’re in a high-pressure situation that you need to be, be aware of what your own needs are so that you can help, do what’s within your power to support your needs, that you can stay in this career in a sustainable and long haul way. And at the same time, so many of the conditions that are contributing to that high pressure, low agency ingredients that we know are exactly what drives burnout often in most cases are coming from the institutions and the organization. Stuff has been baked in, particularly in this culmination of a lot of different things that have happened in health care over the last decade, some say two decades, but certainly in the last decade that have made it one of the hardest times ever to practice medicine in a sustainable way without burning out. And that drove you and some brilliant colleagues to come together and say, we want to create a list of things that are actionable now that health care organizations can do now to do what they need to do on their part to reduce physician burnout. Do I understand that correctly? 

Dr. Shah: Absolutely, Jill. And just to just to underscore what you said, and this is a Tina Shah-ism, but I believe that 85% of burnout is really due to workplace factors. If you look nationally, every person that’s working on burnout, those that are publishing the papers, that are really delving into the science behind burnout. It is an occupational condition. So this is not about doctors not being resilient. We know that doctors are resilient, in fact, more resilient than age-matched peers. So this is completely, nearly completely about what is the tech that we’ve been given to do our jobs, what is the demands of the job, and do we have enough resources for that? What’s the relationship with our manager or is our manager actually listening to us and taking our input to make things better? And are we actually allowed to be ethical and follow morality for what we know to be right and we take care of our parents, or our patients, rather? Or are we being forced into these really sticky situations where sometimes other goals, like business goals or other goals, really get in the way of doing what’s right by the patient. So 100%. And if you want, I can give some more context as to really how this top five hit list came up and then we can go through it. 

Jill: Yeah, I would love to. I think I think it’s really helpful for people to understand how it wasn’t just, okay, well, let’s just pick five things randomly that might be better if this happened, but they’re targeted specifically toward the reduction of burnout in a high impact way if health care systems would start implementing them sooner than later. 

Dr. Shah: Absolutely. So these five recommendations actually came out this year, 2022. And the impetus was this. We’ve been in the pandemic for a long time now, for many, many months. We have the great resignation. We don’t have enough nurses in many cases don’t have enough doctors. And the list goes on and on. And at the same time, we know people care about burnout, if you may or may not be familiar. I strongly recommend you Google at this time the National Academy of Medicine and Well-Being, and you’ll see that there’s a whole collaborative that’s been really pumping out evidence-based tactics and really digging into why do we get burnt out and what to do now. But having a tome of literature doesn’t always help us in the field. We just need to know information. What are the things to do and how can we do it? And so that was the gap. And in early January 2022 this year, that was the question. What can we give that at the reading level of someone who has too many priorities, who’s constantly being interrupted now that that fits the bill for a doctor, a nurse, and also someone in the C-suite, whether it’s a doctor or nurse. And so how do we put it at the right reading level so that our leaders can actually act on this? And so with a co-chair, I actually helped gather a group of thought leaders across the country, and they represent the American Hospital Association, the American Medical Association, Institute for Health Care Improvement, the Dr. Lorna Breen Foundation, Chief Wellness Officers, and the Chief Wellness Officer Network. And then indirectly and this was me acting as a private citizen, although at the time I was also working as a senior advisor to the Surgeon General, just as a group of thought leaders, to say, okay, we have the evidence out there, but what’s doable in three months? What’s doable in 2022 when we don’t have additional resources? And what would be what I like to call it, a clinically significant difference? Not a statistically significant difference. So what actually feels what could be felt in the field? And that’s how we came up with the list. A month later, the list came out. It’s now published on the All In for Health Care website and actually has the endorsement of the National Academy of Medicine because it truly is evidence based and will help right now. 

Jill: Yes. And I really enjoyed hearing some of the not only the ideas, but then some of the, again, practical, tactical things that are implementable within each of those ideas. So let’s jump into the list. And number one is adjust expectations. What do we mean by that? 

Dr. Shah: I think anyone that’s working right now on the front lines or knows somebody that is, understands that we don’t have the same pressures that we had before the pandemic. We’re still dealing with practicing medicine a very different way. But now we have more complicated patients and we just have less resources, whether that’s people or literally supplies. So we need to kind of make some expectation adjustments. And this reminds me of a friend of mine who’s a heart failure physician who told me, you know, on one hand, I’m being told, don’t let patients wait in the waiting room longer than 15 minutes. Right. This is all about patient experience. But on the other hand, she is seeing sicker patients, much sicker than before. And she doesn’t want to shortchange the person in front of her who really needs your help. So this is this is the scenario where we have to adjust expectations and we really need our leadership to back us up to say this is just where we are. We don’t have all the resources we want. What can we focus on the most, knowing that we may not be able to hit every single goal: patient experience, quality, timing, every single thing, optimizing to minimize cost, what we have to do the best job we can with what resources we have. And to give you an example on this, on the inpatient side, I think this is very relevant to nursing, actually, but we work, at least for me, working in the ICU, worked so closely with nurses, there has been some adjustment with adoption of crisis documentation protocols. So instead of maybe documenting, I don’t know, every 2 to 4 hours something about the patient’s status that is not directly related to their medical care. Can we pause that? Can we maybe eliminate mandatory trainings that aren’t directly relevant to patient care, both for nurses and especially for us doctors? So these are examples of adjusting expectations. 

Jill: Yeah, I love it. I think the documentation, really taking a close look at documentation and not just this is how we do it, but really looking at that is going to change a lot of people’s lives. Because in my experience and I’ve said this on the podcast a whole bunch of times, but I’ll say it again, physicians are not afraid of working really hard. It’s the work that’s not directly related to patient care and to supporting patients. And it’s the and especially pointless stuff when you are tired and under a lot of pressure and trying to do the best for your patients and some of the stuff, especially documentation wise, that feels pointless. And I think that leads us into our second point really well that that’s, you know, can be a source of burnout. So really taking a clear look at where things need to be adjusted. Now, I have to say, doing the work that I do, adjusting expectations can create a short-term stressor, right? Because change creates a little bit of a stressor. And so I know that’s why a lot of times people avoid switching the status quo because it’s like, oh, it’s harder to make the change. But that’s just not true, right? Just like the line I hear from people a lot. It’s easier if I do it myself. No, usually that’s not actually true. And it’s not good for a long-term life in the long-term sustainability of your work. Same thing with its looking at adjusting expectations and being willing to make that change can be really integral toward long term satisfaction in your work. 

Dr. Shah: Yeah, absolutely. And I’d love to call out to health systems in case listeners are curious, but if you want it, you can you can actually publish a crisis documentation protocol, sort of a grid, list of what you should do and what you may do for their nurses and I think this was published earlier in the pandemic. Christiana Care is also another health system. This is a system located in Delaware that actually had a system wide message sent out and then followed up with a very tactical grid of what can you document and what can you sort of put on pause while we’re in this unique circumstance? 

Jill: Yeah, I love that. So let’s get to the number two on the list, which is to me directly related in a lot of ways, which is get rid of stupid stuff, right. Or the acronym GROSS. And I think one of the biggest things that I heard in conversations and several of my physician coaching clients is that finally, health care systems are starting to do things like making notification adjustments in electronic medical records because many hospital systems have whatever the regulations are, they double or triple that with the number of notifications that go out. And the overloaded email inboxes are such a source of stress and overwhelm. So for so many of my physician clients, so I love that the health care systems are looking at understanding better how they have to just not just treat this as if it’s like a given in electronic medical records as one example. But any other GROSS things that we need to be getting rid of that you see having an impact on individual physician satisfaction? 

Dr. Shah: Yes. And just to give more context. GROSS, this literally comes from a short piece that was published in the New England Journal of Medicine from a health system that’s located in Hawaii where they coined this term and they literally said one day, we’re just going to ask everyone, what is something you do that just doesn’t have clinical relevance or relevance to your actual profession? And so it was that simple question. There were a load of responses that came back, and I think about 85% of them were actually taken care of. So this is actually not hard. We don’t need new technology. This could be as simple as sending out an email, creating a Google form and getting that ported into an Excel sheet. And then, of course, being transparent with what are we doing, which ones can be actioned on and when and which ones can’t and why. I would also share. There is so much I love that you brought this up, Jill, about there’s the regulation, but then there’s the, I think sort of over interpretation of the regulation, whether it’s coming from the state or federal government or from an insurance plan or even just the internal policy. And we always talk about making sure we don’t miss stuff, but we forget that when you overload a physician, they are apt to miss stuff. And I remember this paper that was published where they polled VA physicians and 30% of primary care docs there were worried that because they received too many in basket messages, that they’re missing something crucial. So we know this, all of us know this. Now you have your EHR in basket, you have your regular email inbox, and what else do we have coming through our cell phone? So I think for me, this isn’t giving examples but is saying, here’s how you do it. You have senior leader buy in and you ask that question whether it’s over email or at a town hall. Get your answers and start working on it. 

Jill: Yeah. And like everything else, leadership, if you’re going to ask the questions and get the answers, then you have to implement them because otherwise it makes people even more unhappy than they were before you asked the question. And so I think that’s just a little side note, absolutely unrequested coaching, leadership coaching that I’m giving my leaders out there to remind them of that. And I think it’s also just if I remember right, hearing about the Hawaii example, it was also just looking at how many people are not operating top of license, right. And doing jobs that were not where they were really trained to do. And that that’s this is a good place to be able to really shore that up as well. 

Dr. Shah: That’s right. 

Jill: Okay. So number three is get radical to shore up staffing. And I love this idea because that’s something that I think medicine compared to other industries that I’ve worked in doing time and stress management work has been very, almost as bad as manufacturing in terms of like, nope, we have our shifts on our schedules and this is the way we do it. And if there’s one silver lining under COVID is we’ve had to think more creatively about this. So what are your thoughts on this? 

Dr. Shah: Well, the word radical is used deliberately because we can’t be just incremental on this one. And thank God we had a lot of good examples pop up in the pandemic out of sheer need. But here I would give you a list of it. I’ll just give you run through a few examples on the nursing side. And again, I think about this as an ICU doc. We can’t do our jobs unless we have nurses. It’s so hard. We come up with the plans together. They are really the executors of the task for the day to take care of patients. So what if you have a retiring nurse who doesn’t really want to do that eight hour shift? Well, maybe he could be at home and then be a virtual nurse buddy to a greener nurse. Maybe be that second check on the blood or that critical medicine that’s being given or that second pair of eyes for a patient that might be deteriorating. So thinking about how you can take nurses that are maybe on the way to retiring or maybe getting burned out and bring them in virtually to be a nurse buddy or maybe do half the day of the shift, maybe do a four hour shift. Why do we have to be so rigid with 8 hours? Thinking more broadly, thinking about physicians, what about really trying to design around life and have better work life integration with how we do our clinic hours? If we had a mixture of virtual visits, whether they’re telephone and video and in-person, can we make it so that a doctor or mom could actually go pick up her child or go see her child at a soccer game and then continue video visits later on in the day at home? There’s just so many ways to leverage technology. And really, if you set it up properly and I would argue this doesn’t take really funding, this takes creativity and forming a brain trust with revenue cycle, with IT and with compliance. You can come up with some really unique ways to mix being a regular human and having family obligations, but then also being able to take care of your patients. And another one I would say, and I think we saw a lot of this early in the pandemic, those that are in leadership that maybe our clinicians are not, but really don’t do much clinical time or those that are non in non-clinical roles really can pitch in. We need more people for transport. We need folks to be at the front desk and answer phone calls that are coming in and having that time on the floor really gives you a different perspective so that when you’re back in your job, you have more meaning. And if you particularly make decisions about how health systems run or clinics run, you have a better appreciation of the day-to-day pain that we feel on the front lines. So there’s endless possibilities on getting radical, whether it’s bringing in new folks, changing shifts, maybe leveling up, bringing in LPNs into the mix, let’s say on the inpatient side, which is something we did decades ago, but really has fallen off. There’s just so many ways to get people to work top of license, and we do need to be radical about it. 

Jill: Yeah, I love that. Here in Saint Louis, where I live, one of the health care systems is piloting a program where the nurses are really saying when they can work their schedules, if they want to opt into that program. And they actually use the restaurant industry as a as a helping with understanding how to do that. Because if you’ve never done it that way before and it was just sort of like we tell you when to work, that was the model that a lot of health care systems have used. It took some learning. But turns out when you have, you know, incredibly capable, intelligent people that have chosen careers, resilient people who’ve chosen careers in health care, if you are willing to try these things and implement them, you can learn fast how to make scheduling adjustments like this that keep people able to work when they have other obligations or want to work a slightly different schedule. So I love this conversation as well. 

Dr. Shah: Yeah, 100%. And I’ll tell you, this specific thing about giving folks their own ability to schedule their days off is actually included in the Surgeon General’s advisory on health worker burnout. So if you haven’t heard about this, I know we’ve been so busy working that probably it’s maybe crossed our desks and then moved on. But for the first time in the history of the U.S., we have the nation’s leading doctor who sits on health and human services in D.C. saying that burnout is a problem. And here’s the blueprint of what we need to do calling on payers, health systems, the tech community, regulators. And one of the things is give us our autonomy back so we can schedule our days off. 

Jill: Yeah. At the prompting of another guest’s not too long after it came out, because I was sort of like, Oh, is everybody going to read that report? And then she said, You know, you should really read it. And I have now and it is excellent. I can’t say enough layperson, professional, leadership anywhere. The more understanding we have on how these systemic changes need to happen, I think it’s good for everybody. So, yeah, thank you for that reminder as well. One of the other things on number four, on this list that you and the other brilliant experts have curated is designating a wellness executive. This there’s so many hospital systems, you know, doing this work for a long time, like, yeah, we want to do this wellness stuff for our people, but it’s sort of always been kind of an add on job or something that just was going to spontaneously happen when the systems somehow from the sky got a bunch of time and money to put toward health care worker wellness. And you’re saying, no, we have to actually treat this in a position with somebody who can focus on this and implement things starting today. Do I understand that right? 

Dr. Shah: That’s right. And I would just say this, it’s inconceivable now that we wouldn’t have a Chief Quality Officer or quality infrastructure. And that’s the same way we need to approach this. It’s not enough to ask, let’s say, the head of a division to take on well-being and not resource them. This is explicitly stating that we need a point person, a person in command who has operational control to really lead us because it’s not easy. It requires implementing wellbeing, tactics, really require crossing silos here. So just like pulling a page from the equality movement in the US, we really need that point person. Now, they may officially be a chief wellbeing officer. In some institutions we have that already. I think in academics we’re far ahead then outside the academic realm. Or it really could just be somebody that’s high up enough on the leadership food chain who has operational control. And I really go back to thinking and this occurs now too, but in the beginning of the pandemic, we had these COVID command centers, right? And so you had all the key people that are the decision makers of the medical institution being there at the table. Now, one of them needs to be in charge of thinking about wellbeing across the entire care system. That’s exactly what this fourth one is. 

Jill: Yeah, I love it. And then finally and this is really important and I think something that we don’t talk about out loud enough in that is EAP is not enough. And of course, that’s employee assistance programs, which, you know, in my common language, I would say that’s when somebody has gotten into a challenging situation or in or in “trouble”, or is having mental health challenges. And so there’s interventions in a lot of health care systems. They’re good at getting in there when the trouble is there has started for somebody mentally or otherwise. But we can’t just wait until somebody gets to that level before we’re looking at support systems is that’s what I’m understanding when I hear this recommendation. How would you say it? 

Dr.  Shah: I would say that and even more. I think if you think about it, burnout is an occupational condition. Right? So to try and treat burnout like a mental health condition and tell us, okay, something’s wrong with you, just go seek mental health care is just not enough. There’s this whole bucket of work where we really need to be supported. Yes, when we have mental health issues. But it’s not enough just to have this 24/7hotline. You actually need to help us stay well, while we’re on the job, both for mental health, when we think about depression, when we think about suicide, when we think about anxiety, the moral distress we have when we see patients that we know we could have helped, but we just couldn’t because we didn’t have the resources. But then also all the factors for burnout. So this is saying don’t think you’ve checked the box and everything’s okay. When you provide EAP, you really need to talk about peer supports like the battle buddy system or helping physicians gather. I love this Mayo Clinic paper that they got published where literally doctors were paid to go have dinner with each other and then talk about physicianhood. This is what we’re talking about. It’s not enough to just do EAP. 

Jill:  Right. That’s on, you know, on the more well side of the mental health spectrum. And then I think the learned brain legislation is really a very important step toward making doctors human and recognizing that when things like anxiety and depression are coming up, you’re not supposed to just battle through that on your own and somehow figure it out. And that the same kind of support that’s available for average folks should be available for doctors without them having to lose or under threat of losing malpractice insurance and things like that, because they’re prescribed a certain medication that supports their mental health. So I think we’re headed in the right direction there as well. Can you give us a brief understanding for those that are maybe still not so familiar with what this Lorna Breen legislation is about and what you think the impact is going to be on mental health support for physicians? 

Dr. Shah: Absolutely, Jill. And I’m happy to report I have the inside scoop. I actually serve as faculty for the grant recipients through the Institute for Healthcare Improvement- IHI if you’ve heard that acronym before and this is incredible. So for the first time, the central government has doled out over $100 million to really help the healthcare workforce. And this is spurred from Dr. Lorna Breen, an incredible physician who was an ER doctor was working in New York and unfortunately succumbed to death by suicide. But this is acknowledging that things are just so hard for us, given what we see, COVID, how the workplace is that we do need to come up with system level tactics and individual supports so that we can really make sure that no one ever gets to the point of having suicidal ideation. And so I’m really pleased to report that the work has already kicked off. There are 44 different institutions that range community health type of institutions to training. So we’re talking GME, we’re talking nursing schools, medical schools and health systems that are all thinking about evidence based tactics to ensure we have mental health supports, but then go even further and address burnout and moral injury. So stay tuned because I think this is huge and in my opinion, this was one point. So my question now is not if the federal government’s going to do more with funding, but when. There is a lot of discussion happening in DC right now about what more do we need to really support our health care workforce, physicians and others. 

Jill: Beautifully said. Finally, I can talk to you about this all day long, and I know you have lots of other important things to do as well, so really do appreciate your time. What role do you see technology playing in the lessening, treatment of lessening and hopefully improvement in the conditions that lead to burnout for physicians moving forward in this incredible career that they have chosen and have succeeded in being able to practice medicine. 

Dr. Shah: Jill, you’re leading me to my favorite topic. I think one of the things we underutilize is technology. And I understand if you talk to the average doctor, they’re going to tell you that the EHR  is the source of so much of my frustration, and it’s probably one of the largest pieces that contributes to my burnout. But let me say this. Technology can be our enabler. We can choose to implement and select technologies that burn us out more, or we can recognize it’s just a tool and it can actually not get us to a state of I’m okay, but to a state where we actually flourish. And so I want to give you give listeners a slightly different example. You may be having this debate with your colleagues. So let me just bring it up. Many of us did telemedicine very early on in the pandemic. Now we’re months out. And the question is, should we do telemedicine? Some people continue on and other people are having this question. But I really want to reframe it to say we have tools. One tool is seeing a patient in the office. Another tool is doing it in a remote patient monitoring way or an audio or video visit type of way. And it’s all about how we pull this into what the true need is, both for us as doctors and for our patients. So I can give you an example where in the beginning of the pandemic, I was settinging up telemedicine for a large health system in Georgia, and I also was still practicing. So feeling the daily pain as we weren’t letting families come into ICUs and all of our clinics were closing down and we actually didn’t have any resources to buy tablets or buy cameras for our position. So really in a hardship type of situation, here’s what we did. We actually came up with a grid that said, what type of visit is it? Is it video, is it audio? Is it responding to a patient portal message? And then in this three-by-three table, there was another column that said one of the minimum things you have to document in the note to be compliant for billing. And then the last one was, and what’s the one code you have to drop? So here is an example of we didn’t add more to the physician by saying Remember which pair it is and then which code it is.  We automated all that. And in cases where we couldn’t, we had revenue folks do this on the back end and we let doctors just be doctors. And I really think that allowed my health system at the time to go from 0 to 50000 filled visits in six weeks. And I saw my colleagues be able to stay home and do that double duty of being a parent and also a doctor and homeschooling their kids, essentially. So this is really the key. I just want to say the game is not over if tech didn’t work the first time, I really want to ask you, how was it implemented? Because this could really get us to a scenario where it’s the iPhone, we didn’t even know we needed. And now that we have it, we just can’t live without it. And it allows us and our patients to thrive. 

Jill: Yeah, really. Just so many great insights. I really appreciate not only how much time and attention you have turned toward tackling this incredible issue, but also taking the time to just so beautifully explain it to so many of us so we have a deeper understanding to help support physicians and hopefully be instruments of change in, as our individual listeners can be, instruments of change to take these ideas in their own organizations and begin implementing them ASAP to see these improvements in conditions which are so desperately needed. So thanks so much for being with us. Dr. Tina Shah. 

Dr. Shah: Thank you for having me. 

Jill: Where would you direct people to get more information that you think could be useful, based on our conversation today?

Dr. Shah: So I would say two things. One, I would actually ask folks to go to the All In for Healthcare website and hopefully, we can tack it on to the end of this podcast or video cast. And then the second thing would be, and you know, I like to consider it light bedtime reading, but actually consider reading through the surgeon general’s advisory on health worker burnout. I would actually start with the graphics. They really hit home. This isn’t just a blueprint for America and thinking about it at the policy level, people using this. But this document in your hand is the key to having a conversation with your leaders, or if you’re in leadership, to convince your colleagues to say, Here’s the report, here’s the evidence. Now, what are we going to do? 

Jill: Absolutely. So we will have both links to the All In for Healthcare website as well as the Surgeon General’s report in the show notes. So for your listeners, all you have to do is check out the show notes wherever you’re listening to us, and we’ll be able to link you to both of those great recommendations. Thanks to all of you for taking the time to be with us. Please share this with colleagues, friends and others. And until next time, I’m Jill Farmer on DocWorking: The Whole Physician Podcast.

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