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Use of Ambient AI Scribes to Reduce Administrative Burden and Professional Burnout

Author/s: 
Kristine D. Olson, Daniella Meeker, Matt Troup

Importance: While in short supply and high demand, ambulatory care clinicians spend more time on administrative tasks and documentation in the electronic health record than on direct patient care, which has been associated with burnout, intention to leave, and reduced quality of care.

Objective: To examine whether ambient AI scribes are associated with reducing clinician administrative burden and burnout.

Design, setting, and participants: This quality improvement study used preintervention and 30-day postintervention surveys to evaluate the use of the same ambient AI platform for clinical note documentation among ambulatory care physicians and advanced practice practitioners of 6 academic and community-based health care systems across the US. Clinicians were recruited by the health systems' digital health leaders; participation was voluntary. The study was conducted between February 1 and October 31, 2024.

Exposure: Use of an ambient AI scribe for 30 days.

Main outcomes and measures: The primary outcome was change in self-reported burnout, estimated using hierarchical logistic regression. Secondary outcomes of burnout evaluated were changes in note-related cognitive task load, focused attention on patients, patient understandability of notes, ability to add patients to the clinic schedule if urgently needed, and time spent documenting after hours. Outcome measures were linearly transformed to 10-point scales to ease interpretation and comparison. Differences between preintervention and postintervention scores were determined using paired t tests.

Results: Of the 451 clinicians enrolled, 272 completed the preintervention and postintervention surveys (60.3% completion rate), and 263 with direct patient care in ambulatory clinics (mean [SD] years in practice, 15.1 [9.3]; 141 female [53.6%]) were included in the analysis. The sample included 131 primary care practitioners (49.7%), 232 attending physicians (88.2%), and 168 academic faculty (63.9%). After 30 days with the ambient AI scribe, the proportion of participants experiencing burnout decreased significantly from 51.9% to 38.8% (odds ratio, 0.26; 95% CI, 0.13-0.54). On 10-point scales, the ambient AI scribe was associated with significant improvements in secondary outcomes of burnout (mean [SE] difference, 0.47 [0.12] points), note-related cognitive task load (mean [SE] difference, 2.64 [0.13] points), ability to provide undivided attention (mean [SE] difference, 2.05 [0.18] points), patient understandability of their care plans from reading the notes (mean [SE] difference, -0.44 [0.17] points), ability to add patients to the clinic schedule if urgently needed (mean [SE] difference, 0.51 [0.24] points), and time spent documenting after hours (mean [SE] difference, 0.90 [0.19] hours).

Conclusions and relevance: This multicenter quality improvement study found that use of an ambient AI scribe platform was associated with a significant reduction in burnout, cognitive task load, and time spent documenting, as well as the perception that it could improve patient access to care and increase attention on patient concerns in an ambulatory environment. These findings suggest that AI may help reduce administrative burdens for clinicians and allow more time for meaningful work and professional well-being.

Keywords 
burnout burnout, professional ambulatory care ambient AI

Physician Stress and Burnout

Author/s: 
Yates, SW

Tens (or hundreds) of thousands of Americans die each year as a result of preventable medical errors. Changes in the practice and business of medicine have caused some to question whether burnout among physicians and other healthcare providers may adversely affect patient outcomes. A clear consensus supports the contention that burnout affects patients, albeit with low quality objective data. The psychological and physical impact on physicians and other providers is quite clear however, and the impact on the physician workforce (where large shortages are projected) is yet another cause for concern. We have all heard the airplane safety announcement remind us to "please put on your own oxygen mask first before assisting others." But, like many airline passengers (very few of whom use oxygen masks correctly when they are needed), physicians often do not recognize symptoms of burnout or depression, and even less often do they seek help. We detail causes and consequences of physician burnout and propose solutions to increase physician work satisfaction.

Keywords 
burnout physician well-being quality workforce

Physician burnout in the modern era

Author/s: 
Marchalik, Daniel

The Library of the Royal College of Surgeons of England is home to a meticulously kept archive of the lives of medical students who attended Sir James Paget's anatomy lectures at St Bartholomew's Hospital in London, UK, between 1839 and 1859. Published in 1869, “What Becomes of Medical Students” is Paget's personal appraisal of his apprentices' achievements, ranging from “distinguished success” to “scandalous misconduct”. Although many went on to differentiate themselves, of the 1226 students under his tutelage, five died by suicide—a rate roughly 25 times higher than the male suicide mortality rate during that period.

Although the knowledge of medicine's heavy toll on its workforce is not new, scant attention has been devoted to this issue historically. But was medicine ignoring an internal crisis? That was the question posed by S Dana Hubbard—the Director of the Bureau of Public Health Education for New York City—in a 1922 letter published in the American Journal of Public Health. Hubbard chronicled the suicide rates of various professions, noting that physicians took their own lives more than twice as often as the next highest field (lawyers). Pointing out that “the occupational strain is greater in medicine than in any of the other professions”, Hubbard insisted that “our scheme of medical practice, as it relates to hours and relief, be revised”. Despite the wide circulation of the letter, few changes materialised.

Keywords 
burnout history
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