Can Low EHR Use Time, Clinician Demand Predict Physician Departure?

While EHR use has been linked to clinician burnout, a study published in JAMA Network Open revealed that less time spent on EHR inbox management may be able to predict physician departure.

This counterintuitive finding is based off a retrospective cohort study that used vendor-derived EHR data to explore physician departure at a large ambulatory practice network. To be clear, the researchers did not find that physicians leave because they are not using the EHR enough; rather, they start to taper EHR use when they know they will be leaving a practice.

The research also revealed that lower demand for a physician’s services—defined as the percentage of available patient time that was scheduled with appointments—was associated with physician departure.

The study authors noted that this finding is consistent with expectations that clinicians leaving their position wind down their practice in anticipation of departure or may leave their position if there is not sufficient demand for their services.

The study also revealed that lower rates of teamwork on order entry were associated with physician departure, suggesting that teamwork may help to prevent physician turnover. This finding is consistent with prior research that indicates team-based care can mitigate clinician burnout.

“Taken together, these findings suggest that a refined, prospective model of vendor-derived EHR data could help to identify physicians at high risk of departure who might benefit from targeted team-based care interventions,” the researchers wrote.

“Indeed, low demand for a physician’s service, time on the EHR and inbox, and rates of teamwork on orders may very well be lead indicators for physicians preparing to leave practice,” they continued.

The study authors noted that if physicians who leave a position are less in-demand or winding down their practice, they may have less EHR work to do which could decrease their use time regardless of health IT proficiency.

“Alternatively, physicians who leave their practice could be more proficient with the EHR and, therefore, more marketable to move to a new position,” they added. “This would suggest that more proficient EHR users are at an increased likelihood for departure.”

However, the researchers noted that they are unable to conclude any more details regarding the relationship between EHR proficiency and physician departure from this study.

“The counterintuitive direction of the association of time spent on EHR activities and physician departure warrants further investigation,” they wrote. “Additional future research could prospectively track physician productivity and EHR use patterns to identify physicians at risk of departure, thereby potentially allowing practice leaders to intervene and retain physicians at the highest risk of departure.”

Additionally, incorporating more detailed analysis of non–time-based EHR use patterns, such as wrong-patient orders and number of clicks per patient, could help determine whether physicians who leave practice and spend less time on EHR work are  more proficient than their peers who stay in practice.

The study authors noted that the main limitation of the study was that the primary outcome—physician departure—did not include a reason about whether the physician left their position to take a new job, retire, or leave the profession of medicine altogether.

The study authors suggested that standardized qualitative exit interviews could provide further insight into the association between EHR use, clinician burnout, and staff attrition.