November 2024

RHEUMATOLOGY

STUDY EVALUATES LINK BETWEEN EMR INBOX VOLUME AND PHYSICIAN GENDER, BURNOUT

​As the rheumatology field faces a workforce shortage, it is vital to address factors contributing to physician burnout. Research in other specialties suggests that:
  • Higher electronic medical record (EMR) message volume is associated with physician burnout.
  • EMR messages have increased since the COVID-19 pandemic.
  • Female physicians receive more messages than their male counterparts.

This study investigated if these patterns apply to rheumatologists affiliated with an academic center. The study was led by Laura C. Arneson, MD, and Brian D. Jaros, MD.
​
How can EMR messages cause burnout?

  • Physicians receive large volumes of EMR inbox messages, which can be time-consuming to address.
  • Physicians' jobs are often not structured to allocate enough time and compensation for addressing inbox messages, on top of clinical and academic responsibilities, which can lead to stress and burnout.

Why did you conduct this study?

We wanted to explore the trends in EMR message volume among rheumatologists and examine the trends over the COVID-19 pandemic. While similar studies have been conducted in other specialties, this was the first study we were aware of to evaluate this topic in rheumatology.
 
Rheumatology patients were particularly affected by the pandemic since they are immunocompromised. Anecdotally, many rheumatologists noticed their patients had a greater need for care and remote contact during the pandemic. Therefore, we hypothesized an increase in EMR message volume in rheumatology during the peak COVID pandemic years.

​We also wanted to investigate whether increased message volume persisted as the pandemic waned, whether female rheumatologists were disproportionately affected, and whether message volume correlated with physician burnout scores.

What were the study’s findings?

The study included 10 female and five male rheumatologists and with a majority having 10 to 19 years of experience.
  • The mean message volume was generally higher for female rheumatologists compared to male rheumatologists across all studied time periods.
  • The message volume increased during the early pandemic period and then decreased, but it did not return to pre-pandemic levels. These findings were similar for both male and female rheumatologists. While numerical trends were observed, the changes did not meet statistical significance. 
  • The study also looked at professional fulfillment and burnout scores. Message volume correlated more with work exhaustion and professional fulfillment than with overall burnout or interpersonal disengagement.

What are the potential reasons for the higher EMR message volume among female rheumatologists compared to their male counterparts?

Previous research has shown that female physicians tend to engage in active partnership with patients and that patients are more likely to perceive them as empathetic and skilled in consensus building. These factors may lead patients to feel more comfortable reaching out to female physicians with questions or concerns, and to have higher expectations for patient-centered communication from them.

​While patient-centered communication should be encouraged in all physicians, these expectations may lead to disproportionately higher EMR inbox volume for female physicians.

Did you notice any differences in burnout or message volume based on the rheumatologist’s specialty or clinical focus?

Due to the logistical challenge of analyzing patient panels on a provider level, the study did not have a methodology to address this question.

Are there differences in burnout rates between rheumatologists practicing in academic centers vs. private practices?
​
The study was limited to Northwestern Medicine data and primarily included participants from the downtown academic medical center. Because of that, it did not provide a comprehensive representation of those differences.
 
To accurately assess the potential differences in burnout rates or professional fulfillment scores between these practice settings, future research should include a more diverse sample of participants from various practice settings. 
Laura Arneson, MD, Assistant Professor of Rheumatology and Co-leader of the Health Equity & Advocacy Curriculum at Northwestern Medicine 
​Brian D. Jaros, MD, Assistant Professor of Rheumatology and Associate Program Director for the Rheumatology Fellowship at Northwestern Medicine

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