Challenges in addressing social drivers of health are increasing physician burnout
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Addressing social drivers of health is a critical aspect of a primary care physician’s job, but it is also contributing to rising levels of burnout and “has a major impact” on physicians’ mental health, according to The Physicians Foundation.
The nonprofit organization recently conducted a survey of physicians in America to examine how social drivers of health (SDOH) affect them and their patients. SDOH can include factors like food and housing insecurity, transportation problems, difficulties with utilities and interpersonal safety, according to the survey report.
Physicians have long recognized that “the conditions in which people are born, grow, live, work and age have a major influence on patient health” and the cost of American health care, Gary Price, MD, president of The Physicians Foundation, and CEO Robert Seligson wrote in the introduction to the survey’s report.
Of the 1,502 physicians who were surveyed (33% PCPs), nearly all said that their patients’ health outcomes are affected by at least one SDOH, with 23% reporting that their entire patient population was affected. The top two SDOH were financial instability (34%) and transportation problems (24%).
Although most of the responding physicians agreed that addressing SDOH is important, 61% also said they do not have adequate time or ability to effectively address the issues.
More than 80% of those surveyed said that, along with limited time, “insufficient workforce to navigate patients to community SDOH resources” was the greatest challenge impacting their ability to address SDOH. In addition, 77% of physicians also reported inadequate access to community resources and information.
The surveyors noted that female physicians were significantly more likely to be impacted by the top challenges than male physicians. They additionally wrote that Asian physicians were more likely than white physicians to report limited time (92% vs. 88%), insufficient workforce (88% vs. 83%) and challenges in accessing community resources (83% vs. 76%). Hispanic physicians were also more likely to report challenges in accessing community resources (86%) and inadequate information about community resources (86%) when compared with their white colleagues.
Most physicians — 87% — agreed they want more time and ability in the future to address their patients’ SDOH. But nearly the same number — 83% — believe that addressing SDOH contributes to burnout rates.
Sixty-three percent of physicians said they often have feelings of burnout when trying to address their patients’ SDOH; 68% reported that managing their patients’ SDOH has a major impact on their mental health and well-being; and more than half said they experience stress or frustration on a daily or weekly basis because of SDOH challenges.
Although eight in 10 physicians believed that the U.S. cannot reduce health care costs or improve health outcomes without addressing SDOH, “our current health care system does not operate in a way that includes addressing them” the surveyors wrote.
These factors are becoming even more important, as SDOH drove 70% of health outcomes even before the COVID-19 pandemic, which 89% of physicians agreed is “likely to exacerbate social conditions that cause poor health.”
PCPs are now seeing these effects as the pandemic continues. Patients who are returning to primary care offices and hospitals are presenting with conditions that were worsened by lost jobs and the struggle to afford rent, food and more, Price and Seligson wrote.
The physicians who believed that the U.S. must address SDOH said that the following strategies will be important in supporting their efforts:
- investing in the community’s capacity to address patients’ SDOH;
- investing in the technological and human capacity to connect patients to community resources;
- assessing patients to identify social needs;
- significantly reducing administrative burdens such as payer reporting requirements to allow time to address SDOH; and
- creating financial incentives for physicians to address SDOH.
According to The Physicians Foundation, “physicians are held responsible for patients’ health through quality measures and financial rewards or penalties that focus almost entirely on clinical care, not including SDOH.”
To change this norm, physicians said that payors need to be incentivized to invest in the availability and quality of community resources; Medicare Advantage needs more flexibility to reimburse for addressing SDOH; and SDOH needs to be integrated into payment policy.
“As we continue building broad-based understanding of SDOH and their implications for patients and physicians, it is critical that physician and patient voices remain central to the discourse and decision-making,” the report stated. “It is through addressing SDOH that we can improve patient outcomes for everyone and ensure that the physician workforce is well supported and financially recognized for its partnership with patients.”
Perspective
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Patients in the U.S. currently have several unmet social needs, and this represents a major issue in our nation. This survey highlights that not only do patients have multiple social needs that influence their overall health, but that physicians do not have the time to address these needs, which is further contributing to physician burnout.
Burnout is a significant problem for physicians, but when assessing how physicians’ inability to personally address patients’ social needs influences burnout, it is important to reframe how we think about this issue. Addressing patients’ social needs is not just an issue for physicians. Rather, it is critical to adopt a team-based approach to addressing patients’ social needs, and we need to create an environment in the clinical setting that allows every interprofessional member of the health care team to practice at the top of their license in order to improve patients’ outcomes, as well as reduce burnout among all members of the health care team.
Our health care system is broken, and it has not traditionally been set up to allow patients’ social needs and health needs to be simultaneously addressed. Instead, it has been focused on primarily addressing patients’ health needs. However, we have seen that unless patients’ social needs are met, our patients are going to have continued poor health outcomes, and we really must implement a comprehensive approach to addressing the health and social needs of our patients.
In order to do this most effectively, we must rethink how we pay for care, what services are reimbursable in the clinical setting, and how we can transform the systems in place so that we may provide comprehensive care. We should be paying for and supporting team-based, interprofessional care, which is critical if we are going to comprehensively address patients’ health and social needs in order to facilitate better health outcomes for our patients.
In addition, for patients who have more complex health and social needs, we need to ensure that as a health care team, we are able to spend more time to address our most vulnerable patients' needs during and after the clinical encounter, and that these services are paid for, so that we can do our best as an interprofessional team to optimize the health of our patients and keep our highest risk patients from developing avoidable complications, poor health outcomes and increased ED visits and hospitalizations. The bottom line is that we must invest the necessary time and resources on the preventive side using a team-based approach, so that we successfully prevent avoidable poor health outcomes for our patients to improve the health of our communities and reduce instances of health inequity.
As we work to transform our health care system to better support good health, we must also ensure that systems are in place to better understand patients’ social needs. We currently lack a streamlined approach to identifying patients’ social needs, and without robust data defining patients’ existing social needs, it makes it more challenging to address our patients’ social needs both individually, as well as more broadly at a systems or community level.
One approach to improving identification of patients’ social needs includes using ICD-10 Z codes denoting social determinants of health when performing social needs screenings for patients. Although not a perfect solution, using ICD-10 Z codes can help begin to capture the social needs of patients within the electronic health record. If more practices and health systems begin using ICD-10 Z codes to code for patients’ existing social needs, not only will this help clinics better identify their patient populations’ social needs at the practice level, but this data can be used to better understand patients’ social needs at a local, state or national level, which can improve our ability to systemically address some of our patients’ needs by employing population-level interventions to improve outcomes.
Regardless of the approach we take to improve social needs data collection, we must ensure adequate funding and support for this data collection, so that we build systems that can best identify existing needs and then use the data to determine how to best allocate and distribute our resources to comprehensively address our patients’ social needs. In the end, it is critical that we develop a system to collect social needs data, so that we understand our patients’ existing needs, and can provide interprofessional team-based care, where every member of the health care team works at the top of their license to address patients’ unmet social needs and serves as an advocate for our patients, so that we may make changes at the local and national level and create supportive policies and funding in order to comprehensively address the health and social needs of our patients, decrease instances of burnout and improve health outcomes.
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The Physicians Foundation 2022 Physician Survey. https://physiciansfoundation.org/physician-and-patient-surveys/the-physicians-foundation-2022-physician-survey-part-1/. Published April 5, 2022. Accessed June 7, 2022.
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