Burnout is quickly becoming a health crisis for providers and patients, according to the American Medical Association. A Mayo Clinic study highlighted alarming trends in physician burnout: 62% of physicians had at least one symptom of burnout in 2021 compared to 39% during the prior year, and organizations across the country have seen little improvement since. Amidst a nationwide provider shortage, understanding burnout and developing effective, achievable solutions are key to helping clinicians have more time to do what they do best – provide clinical care for their patients.
Reasons for burnout
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Several factors contribute to provider burnout: ever-increasing administrative tasks, electronic medical record documentation, too little time per patient, as well as the needs of patients between visits. Providers shoulder most of the responsibility for direct patient care as well as visit documentation and typically operate in silos. There is often not enough coordination and collaboration among siloed clinicians regarding patients in their care, despite their best intentions.
The nuances of treating mental health can exacerbate burnout, too. Due to competing clinical demands, primary care providers often do not have enough time, resources, or mental health domain expertise. To get the best outcomes, primary care providers need to: screen for mental health issues like depression and anxiety; educate patients about the rationale for treatment with medication and evidence-based psychotherapy approaches; and monitor symptoms and side effects; all of which takes extra time. This is virtually impossible in the typical 15-to-20-minute primary care visit.
Psychiatric collaborative care improves health outcomes
The psychiatric collaborative care model offers an opportunity to mitigate burnout by reducing the burden placed on primary care providers (PCPs) and more effectively supporting their patients with behavioral health needs. In psychiatric collaborative care, clinicians work in unison – from the psychiatrist to the PCP to a care manager – and they partner to assess the efficacy of a patient’s care plan. In real time, they can make adjustments to address evolving patient needs.
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In particular, psychiatric collaborative care creates a strong support system for clinicians as they manage their patients’ complex behavioral health issues; the addition of a psychiatrist’s expert input is key to the collaboration. Moreover, regular outreach to the patient by the behavioral health clinician – monitoring symptoms and side effects, measuring depression and anxiety levels, and providing evidence-based psychotherapy, coaching and health activation support – provides a level of support that extends the reach far beyond what primary care providers could do in traditional practice, i.e., “usual care.”
Further, such a psychiatric collaborative care model can help alleviate clinician burnout by having regular touch points to provide support and answer questions, which would otherwise fall solely on the PCP. Of note, the most advanced collaborative care programs allow for expedient, ongoing access to psychiatrists, alleviating standard administrative burdens associated with psychiatric consultation requests.
Tools to support psychiatric collaborative care
Effective psychiatric collaborative care models can really help primary care groups and improve patient health outcomes. However, primary care groups should evaluate programs before adopting to make sure the selected model will help alleviate provider burnout while supporting collaborative care efforts.
Features of effective psychiatric collaborative care programs:
- Impact analysis: the program should identify patients who are most likely to benefit from the collaborative care program.
- Evidence-based interventions: these should include evidence-based psychotherapy, clinical decision support tools, and real-time interactions with psychiatrists and care managers.
- Frequent reviews: updates provided to the primary care provider on a regular basis – think weekly, not monthly – so the care team can adjust the plan as needed.
- No patient excluded: regular case review evaluates all patients, even those who do not show up; the collaborative care team helps the primary care provider by supporting patients in engaging in their care.
Support move to value-based care
With the push to value-based care already underway within the nation’s largest payers , such as UnitedHealthcare Group, Humana, and CVS/Aetna – primary care groups need programs that help them succeed in value-based care arrangements.
Compared to fee-for-service arrangements, value-based care models incentivize PCPs to spend more time with their patients. Specifically, value-based care offers clinicians compensation based on performance and demonstrated patient health outcomes. As such, value-based care can include longer appointment times, more frequent visits, and smaller panels, with an emphasis on prevention and lifestyle changes to improve health. With primary care practices positioned as the quarterback to coordinate all aspects of care, including mental health care, they stand to gain with the new value-based model, especially when leveraging a results-driven psychiatric collaborative care model to address their patient’s mental health needs.
Patients and clinicians benefit
When properly supported in offering psychiatric collaborative care, primary care groups can expect to see a reduction in their burnout rates. Success will appear both in quantifiable return on investment for PCPs and improved health outcomes for the patients they serve. Clinicians owe it to themselves and their patients to implement the psychiatric collaborative care model.
Photo: PeopleImages, Getty Images
Paul Ciechanowski, MD, MPH spent several years as a family doctor before becoming trained as a consultation-liaison psychiatrist. He is a national leader in the psychiatric collaborative care model. He has conducted NIH- and CDC-funded research in developing the model and has trained hundreds of healthcare systems throughout the U.S., Canada, and India in implementing the model. He and his colleagues at the University of Washington developed the PEARLS Program which is now a national program for helping underserved older adults with depression and chronic conditions. He is the Chief Medical Officer of Janus Healthcare Partners and continues to see patients at the University of Washington Medicine Diabetes Institute.
