The impact of time spent on the electronic health record after work and of clerical work on burnout among clinical faculty

Abstract

Objective: To identify specific thresholds of daily electronic health record (EHR) time after work and daily clerical time burden associated with burnout in clinical faculty.

Materials and methods: We administered an institution-wide survey to faculty in all departments at Mount Sinai Health System from November 2018 to February 2019. The Maslach Burnout Inventory and Mayo Well-Being Index assessed burnout. Demographics, possible confounding variables, and time spent on EHR work/clerical burden were assessed.

Results: Of 4156 eligible faculty members, 1781(42.9%) participated in the survey. After adjustment for background factors, EHR frustration (odds ratio [OR]=1.64-1.66), spending >90 minutes on EHR-outside the workday by self-report (OR = 1.41-1.90) and >1 hour of self-reported clerical work/day (OR = 1.39) were associated with burnout. Reporting that one's practice unloads clerical burden (OR = 0.50-0.66) and higher resilience scores (OR = 0.77-0.84) were negatively associated with burnout.Spending >90 minutes/day on EHR-outside work (OR = 0.66-0.67) and >60 minutes/day on clerical work (OR = 0.54-0.58) was associated with decreased likelihood of satisfactory work-life integration (WLI) and professional satisfaction (PS). Greater meaning in work was associated with an increased.

Likelihood: of achieving WLI (OR = 2.51) and PS (OR = 21.67).

Conclusion: Results suggest there are thresholds of excessive time on the EHR-outside the workday (>90 minutes) and overall clerical tasks (>60 minutes), above which clinical faculty may be at increased risk for burnout, as well as reduced WLI and PS, independent of demographic characteristics and clinical work hours. These thresholds of EHR and clerical burden may inform interventions aimed at mitigating this burden to reduce physician burnout.

Keywords: burnout; clerical burden; clinical faculty; electronic health record; well-being.

Figure 1.

Relationship between daily time spent on the EHR after work and clerical work with burnout on the MBI-2 and WBI: a. Relationship between unadjusted burnout prevalence on the MBI-2 and daily time spent on the EHR after work and clerical time. b. Relationship between unadjusted burnout prevalence on the MBI-2 and daily time spent on the EHR after work and clerical time. c. Relationship between adjusted burnout odds on the MBI-2 and daily time spent on the EHR after work and clerical time. d. Relationship between adjusted burnout odds on the WBI and daily time spent on the EHR after work and clerical time. *Represents significantly different results from the null hypotheses based on Bonferroni corrected p values for Chi-square analyses. **Represents significantly associations on the multivariable logistic regression. Abbreviations: EHR, electronic health record; MBI-2, Maslach Burnout Inventory 2 item; WBI, Mayo Well-Being Index.