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Focus on equitable, not equal, schedules to help prevent provider burnout

Insight Article - November 4, 2021

Staffing Models

Business Operations Technology

Culture & Engagement

Patrick Hunt MD, MBA
Medical groups face historically high levels of provider burnout as growing patient and administrative demands further contribute to provider shortages exacerbated by COVID-19. Practices are struggling to balance their organizations’ staffing needs with their providers’ individual needs in an effort to satisfy, retain, and attract top talent.  

Many practice managers have tried to strike the right balance through schedule equality. They strive to ensure all physicians work an equal number of hours, get an equal shift distribution, and receive comparable weekends and holidays off. While this approach is well-intentioned, unfortunately, it is not an effective solution. In fact, it can be more harmful to providers and practices in the long term. 

To reduce burnout and enhance provider satisfaction, practices should stop trying to create equal schedules. Instead, they should focus on developing equitable schedules. 

What burnout looks like and steps to mitigate it

Understanding why equitable schedules are more effective than equal schedules requires understanding the signs of burnout. This includes identifying physicians who want to reduce their hours or, more importantly, those whose performance has declined. 

Long shifts and overnight hours take a physical toll on the body, so there is a natural tendency to work less, especially as providers age. However, practice managers should look for deviations in that natural progression, such as when physicians are not as engaged, not as interested, and not as happy at work. Providers who feel underappreciated or that their work is no longer meaningful may be more willing to give up hours, which increases stress on the group as a whole and can be detrimental to patient care. 

To mitigate such influences, practices should engage in open conversations with their physicians about their work and preferences to plan as far ahead as possible. This enables sufficient coverage with the ability to reduce hours or shifts as needed. Practices can also allow providers to take an extended sabbatical. Providing short- or long-term breaks could help prevent early retirement and keep your practice fully staffed as the coming physician shortage looms. When possible, keeping a practice at maximum capacity or over-staffed allows for more regular time off intervals for all providers. 

A full rotation is vital to supply scheduling relief when physicians begin to show signs of needing an extended break. Yet even without running at the ideal staffing capacity, practices can still afford relief and satisfaction by building equitable provider schedules. 

What equitable scheduling looks like

In its simplest form, equitable scheduling would seem to mean that physician A has the same number of shifts as physician B, and physician A’s percentage of nights and weekends is the same as the percentage worked by physician B.

While this may be the simplest explanation, it becomes fairly inaccurate in practice. 

There are myriad factors that make it impossible for all physicians to work the same number of days, weekends, nights, and holidays. Furthermore, a shift-for-shift schedule doesn’t account for personal preferences or shift desirability. For instance, a group may have some physicians who prefer to work nights, while others with childcare issues would rather work mornings. Or some physicians may prefer a larger proportion of telehealth shifts, while others are more adamant about in-person practice. 

To account for this variability, healthcare organizations can consider adjusting the pay value of different shifts to create a marketplace for less desirable shifts. As such, those who are willing to work those shifts can work fewer shifts overall and still earn the same income or reach the same targets.

The ability to accommodate equitable schedules and nuances keeps providers happy and helps avoid burnout. The efficiency of equitable scheduling stabilizes the practice’s needs — in terms of shift coverage — with the providers’ work-life balance and monetary needs. 

Common types of scheduling to avoid

An Excel spreadsheet or piece of paper will never outperform an algorithm designed to generate a fair and balanced schedule. There simply are too many permutations. No two staffs within a group practice are the same, and scheduling obligations vary by each practice’s specialty, location, and patient mix. 

Here’s the caveat: A schedule created by an algorithm that ensures each provider receives an equal number of hours may cover all necessary shifts within each practice. But if providers are scheduled for shifts they don’t want, are scheduled during requested time off, or if they are asked to work multiple weekends in a row, then that equal schedule can still lead to burnout.

Alternatively, the template-type schedule used by many practice managers has some benefits. Providers working in this scenario typically are prepared for their work schedules up to 12 months in advance. The downside? Providers are required to build their lives around their work schedule instead of the other way around. 

Practices that take a flexible and equitable approach to scheduling empower providers to build their work around their lives, promoting a better work-life balance.

How to prevent burnout over the long term

When it comes to scheduling, practices need to have the right tools for the job. Many technologies can generate a schedule, but they are not built as an inclusive part of a more holistic solution. Therefore, they miss the equity mark.

Intelligent and holistic algorithms can identify inequitable schedules to help practices focus on better balancing providers’ varying needs. Healthcare leaders should look for a solution that takes preferences and compliance regulations into account and uses algorithmic calculations to create and rank multiple schedule iterations to allow practice managers to choose the best schedule for their unique situations. Equitable schedules that weigh human factors alongside practices’ operational needs can help ensure physicians feel heard, appreciated, and engaged in meaningful work.

About the Author

Patrick Hunt
Patrick Hunt MD, MBA
ER Physician and Chief Medical Officer QGenda

pat.hunt@qgenda.com

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