Laurie McGraw, SVP American Medical Association: How to Support an Overburdened Physician Workforce

Van Ton-Quinlivan: Welcome to WorkforceRx with Futuro Health, where future-focused leaders in education, workforce development and healthcare explore new innovations and approaches. I’m your host Van Ton-Quinlivan, CEO of Futuro Health.

It’s been a challenging couple of years for frontline healthcare providers, and physicians are no exception. The pandemic brought a lot of change and challenges, but even before COVID, there were major trends impacting doctors including burnout, adjusting to new technologies and how they affect workflows, and making sense of how to apply an ever-increasing amount of data at their fingertips.

I’m going to explore these issues today with Laurie McGraw, senior vice president of Health Solutions at the American Medical Association. She has spent her career leading health information companies that brought innovative technology to healthcare, and in her current role, she has responsibility for data solutions used across the U.S. healthcare industry. She’s also a board member and strategic mentor for a wide range of technology and health care organizations, an advisor to the Women in Leadership program at George Washington University School of Business, and host of the podcast Inspiring Women with Laurie McGraw. Thanks so much for joining us today, Laurie.

Laurie McGraw: Thanks, Van. It’s great to be talking to you again. Thanks for having me.

Van: Absolutely. What do you hear from American Medical Association members about workforce trends and challenges?

Laurie: I think you covered some of the key topics, Van. We are now crossing two years into this pandemic, and even before we were in the pandemic one of the major issues that the AMA has been working on and continues to work on, are the issues facing physicians — anything that gets in the way of them seeing their patients which results in burnout. The pandemic has only exacerbated it to a near breaking point. We’re seeing the challenges and the stress upon physicians because of the pandemic’s surges and hopeful recoveries, only to be taken backwards.

Some very recent research that the AMA is talking about is showing that the level of stress and burden is resulting in physicians considering leaving the workforce. We are looking at one in five physicians in a recent study considering leaving the workforce in the next two years, and one in three physicians of about 20,000 respondents across 120 plus organizations saying that they would be looking to reduce the amount of time that they’re spending caring for patients. So, that will only exacerbate an already challenged level of workforce that’s out there.

Van: What are you hearing, Laurie, as ways that healthcare executives are trying to mitigate some of these trends and these numbers? They are very dramatic, as you mentioned.

Laurie: They are. If the statements come true, it will only put more burden on the overall healthcare system. So, why the stress? I think we don’t need to think too hard to understand how stressful the pandemic has been for frontline physicians and clinicians, but burnout comes from a lot of different things. Burnout comes from the workload of technology that’s not built into workflows. Burnout comes from not feeling valued. Burnout comes from other challenges. Those might be financial challenges. They might be distribution of work, and things of that nature. So, from an AMA perspective, it is paying a lot of attention — through education, resources, policy changes and advocacy work — to help alleviate these challenges. It is a very significant problem.

Van: Your members have seen the increased use of telemedicine and telehealth during the pandemic. There’s also been a lot of press around incorporation of AI solutions and other forms of digitization. How’s the AMA helping its members keep up with all of these changes?

Laurie: First, all of these digital health solutions and AI — the AMA calls that augmented intelligence — they have been in the works for quite a bit of time. But the level of adoption hasn’t met the opportunity that comes with that level of innovation. And then – boom! – the pandemic, and we saw an absolute explosion in terms of the adoption of digital health tools and telehealth and that became the main way of seeing patients during the pandemic. That is maintaining, even though the levels of adoption and number of telehealth visits have lowered a bit in recent months.

At the same time, there’s the need to deal with that enormous, rapid adoption. We saw ten years of adoption in a period of months. So, what is needed?  Education; work on ensuring that there is appropriate reimbursement for the adoption of those tools; playbooks; actual tools to advise practices for how to ensure that digital health is adopted into workflows. Those types of things, if done well, can allow for physicians to easily adopt the great innovations. But if not done well, it only leads to that negative cycle of more burden and more disruption which is, as we just mentioned, a real problem in healthcare today.

Van: One of our prior guests was Walter Greenleaf at Stanford University, and his advice for young people who are considering a career as a physician was that they really should have familiarity with any and all forms of technology. One of the pilots we have at Futuro Health is a project with UC Berkeley pre-med students where we’re training them on telehealth skills so that they can work with public clinics but also gain exposure to technology-enabled services, as well as giving back to the community. What advice do you have for people who are considering a career as a physician?

Laurie: First of all, for younger people who are considering being a physician, technology is absolute. And fortunately, younger people are digital natives so these tools and technologies are not necessarily foreign to them. At the same time, they need to be incorporated into workflows for all those reasons. I think for physicians today, or people who are aspiring to be physicians, there is a tremendous amount that’s required. Not only do you have to be clinically educated but you need to be technology educated. As a physician, you are also a trusted voice. So, how you advocate and use that voice and educate — in a time when there’s tremendous misinformation about health care and things of that nature — is another thing that does fall to be a responsibility for physicians.

At the same time, when people are pursuing being a physician, they’re doing it from a place of service, they’re doing it from a place of wanting to help people. As you well know, Van, the level of education and years that you need to put in to become a practicing physician is a lot! So, getting prepared is certainly advised. There are lots of resources that are available, but the profession is just chock-full of people who are doing fantastic work.

Van: Laurie, you mentioned that there are resources because it’s a very long journey to become a physician. I was wondering if you could mention what are some resources — financial resources, support resources — that are available out there for people who want to become physicians? And are there added resources for those who are not so young and are doing a mid-career change? Is there a different path that you can take to become a physician?

Laurie: Yes. There are tremendous resources in terms of just education. Of course, the American Medical Association provides information. We have an education hub, we have tools and podcasts and playbooks for residents and students about how to prepare for medical school and how to understand the finances that would be needed for medical school. There’s also networking opportunities. We have been in a virtual world for going on two years, so the AMA provides many opportunities for physicians to interact with each other through different mechanisms. Again, all of that information is available on the website and through other means.

Van: Are there other occupations and roles that surround the physician that are available as career opportunities for communities?

Laurie: Van, as we’ve talked about before, the shifts in the workforce are changing and the challenges for the workforce — physicians, mid-levels, nurses, and other types of healthcare professionals — are changing and they’re changing rapidly. Maybe I’ll just hit on a couple things. We know that there are shortages. We know that there is burnout. We know that there are other stressors that are out there. So, we need to reduce the burnout. We need to fix the stressors. One example is in the area of technology.

The AMA does a lot of research in this area, studying what do physicians think about technology and innovation, and the answer to that is they love it! They love innovation. But the thing is, they care about innovation as long as there’s clarity that it works, that they know how they’re going to be reimbursed for the use of new innovations, that they know what the liability issues are, and most importantly, ensuring that it works within workflows. Otherwise, it creates other stressors and burnout. So, we need to address those things as we go into a time where the type of disease burden that is upon this nation is really mostly in the area of chronic conditions.

There’s all kinds of opportunities with digital health solutions, but that will require other types of healthcare providers, not just physicians. There are other types of coaches or other professionals that can help. Just as an example, the AMA does quite a bit of work in diabetes. Ninety million Americans have pre-diabetes, and it could be prevented. There was a partnership with the YMCA for health coaches to help with pre-diabetes so that the onset of diabetes, which can be debilitating, doesn’t occur. Well, that requires new workforce distribution. Who are these health coaches? How can you as a person sign up for one of these things and help manage your own health? How can the physician workforce be supplemented and augmented in ways to care for what is a growing burden of disease across the nation? I mean, Van, what are your thoughts? You know how large of an issue this is we’re facing.

Van: Well, it’s fantastic that you had this YMCA pilot. I’m wondering what your thoughts are on taking that to scale? Because you’re absolutely right. As you watch the innovation leaders and how they do this work, it does inform how the workflow changes and therefore how skillsets change. And it allows us to look around the corner and pre-think about how we need to retrain or think about the skillsets and qualifications of individuals.

Laurie: Right. And how do they then get licensed? How does that become an easy process? How do you know where the workforce needs to be? There are opportunities with virtual care. There are opportunities with digital health. But we also have issues with hospital closures in rural health settings, and what do people do there? Sometimes there’s no substitute for seeing that physician in person. So, for all of this wonderful advancement of telehealth, we still need to have physicians and locations throughout the country where people can access the resources that they need.

I think that from the AMA’s perspective, we need the things that you are doing at Futuro Health…ensuring that the workforce is there to meet and match the moments of need. We know that we need scalable solutions and that starts with education. Certainly, lots of research, but then removing the barriers that get in the way.

Van: Laurie, we talked about whether there could be an efficient way to rapidly prototype the curriculum and articulate the standards that are needed. For example, the health coaches you mentioned. It would be so much easier if that were centrally developed and then all of the education institutions can peg their respective curriculums against that standard, rather than each one developing its own unique flavor which could lead to healthcare employers not being able to tell the difference between one credential or one degree over another in terms of the quality of the workforce. So, it sounds like there could be more work done in this space, and this type of work is best done as an ecosystem of the willing coming together, rather than any one organization bearing the full burden of doing this work.

Laurie: I agree with that. The AMA does a tremendous amount of work in education for physicians, which of course makes sense. But for the growing list of other types of healthcare professionals and the opportunity that can come with the complement of those other professionals for managing chronic disease burden, how will they be educated? How will we know they meet certain standards that need to be developed? I do think ecosystem, scalable types of thinking is needed. It’s an evolving space, but we know that this workforce is needed to care for the health of the nation.

Van: So, Laurie, one of the things that affected physician burnout is frustrations with electronic medical records, and you have extensive background in this area. I was wondering what your perspective on that is?

Laurie: Well, I spent well over twenty years working on electronic health records, and I’m proud of that work. It was quite a big lift. When I started, less than five percent of physicians had adopted electronic health records, and now it’s ninety-five percent plus, in terms of adoption. The original promise of paving that clinical information highway was different than what the result was. I don’t think anyone would want to go backwards, but nobody anticipated that physicians would go from doing two hours of administrative work for every hour of seeing patients. I mean it’s a complete reversal of what you would want — burden, burnout, and all the stress that comes with that.

So, what happened? It’s not just that the tools themselves weren’t optimized, but there have been additional administrative requirements that have been put on the physician. It’s upside down. For example, the level of administrative overhead with areas like prior authorization is enormous for physicians who simply want to care for their patients with the best clinical decisions that they’re making. Now, they have to do it through all these administrative hoops for prior authorization.

AMA is working on things to try and right-size prior authorization so it isn’t at this level of administrative overhead. I think there’s absolutely more that the technology companies can do to reduce the overhead of the tools, such as working in the workflow, and reducing the clicks needed. There’s more policy work that can be done to change some of that administrative overhead. But, Van, it’s got to happen. It needs to happen at a more rapid pace because these burdens are real and we need to be addressing them.

Van: I’m glad that the AMA is taking leadership on that. My father is a physician, an anesthesiologist. He’s retired now, but I can hear him as you talk. I can hear him express frustration around the administrivia and how he had to do more of that versus direct patient care, which he loved. So, thank you for taking that on.

We talked a little bit about the team that needs to augment the physician in order to offload some of the work that doesn’t require someone who’s got doctor-level training to do — for example mid-level providers such as physician assistants and other allied health professions. What impact is that having on doctors? And what advice do you have for us as you see these trends continue?

Laurie: The big shift is now in team-based care and how physicians practice when they are in teams rather than as individual practitioners. So, that includes a lot of additional mid-level participants and needing to coordinate across where their patients are being seen. From an AMA perspective, we do quite a bit of work in the area of medical education making sure that physicians are prepared for this team-based care, and making sure that there is the appropriate scope of practice in terms of who is doing which things. But the trends of more mid-levels in the workforce…they’re definitely some of the fastest growing areas of professionals that are out there.

As we’ve been talking about, it’s needed. We need more health care professionals. Physicians are certainly being impacted with the stressors and the burnout, but that is true across other clinical professionals. We need to focus on developing excellent workflow, streamlining, reducing the stressors, and having technology work in the background. It should not be the most important thing that the clinical professionals have to do. The technology should work for the professional, not the other way around.

Van: Is there any other point that you’d like to make with regards to the physician workforce?

Laurie: Well, I think I’d emphasize the issues of burnout and the issues of physicians feeling valued by their employer. We have more physicians who are being employed now than owning their own practices. That is a trend that has just been continuing and we need to address those issues. We have opportunities with innovative technologies like digital health, virtual care and digital therapeutics that can help providers keep pace. There’s a shift that is happening before us and I think that we need to be attentive to the multiple angles of making it easier for physicians to do what they do well, and they want to do most, which is care for their patients.

Van: I’m glad you’re working with the nation to drive interest and attention into these workflows. So, thank you, Laurie. Well, let us end by having you tell us more about your podcast, Inspiring Women, which is how we first met. Why did you decide to launch it, and is there anything else you’d like to share with us?

Laurie: Well, thanks, Van. I so appreciated you joining me for that. As a professional and a woman — often one of not many around the table — I’ve always been an advocate for women and women pursuing leadership opportunities. I think with the pandemic, the podcast just became something that I wanted to do. I had done, personally, several podcasts like this one, and had found it to be a great forum. I just thought it would be terrific to start to speak out loud to other women.

So, on this podcast, I talk to two types of women. Women like yourself, Van, who are amazingly accomplished, decorated, have “been there, done that,” and risen to significant leadership positions. I like to hear their stories. And then I also like to speak to younger women who are just starting out, who are aspiring themselves. I think by just sharing those conversations, other women can learn and maybe hear someone else that is having an issue that they’re facing themselves. We’re seeing more women leave the workforce. We’re seeing more broken rungs in the ladders to leadership for women. These are not new issues, but they haven’t changed at the pace that they should have. The pandemic has caused more problems for women, so it will take longer to achieve equity around the board table or the leadership table. So, this is my small way of trying to do something there, and it has just been a lot of fun having those conversations.

Van: What advice would you give to younger women starting out, now that you’ve interviewed a few?

Laurie: My advice is to push hard and ask for what you want out loud to somebody who can give it to you. I find consistently that women do not appreciate how competent and capable they are, and they can do more to advocate for themselves. There are all kinds of systemic issues that need to be addressed, but I implore women to speak loudly and advocate for themselves. We need more of them in those leadership positions, and the talent is there.

Van: Laurie, is that advice different for mid-career women?

Laurie: It isn’t. You know, Van, that’s such a good question. I’m going to tell you something interesting. I was talking to another woman the other day and she was saying that with mid-career women, it’s like they are used to sort of being recognized and perhaps pulled into their next position, but then there’s a certain place at which you need to advocate for yourself to be recognized for what are the fewer, next-level leadership positions. Women perhaps don’t appreciate that, and it can go into a negative cycle. So, the need is to advocate for yourself and to realize that networking is something you should always be doing in your career, not just when you are trying to pursue something. That advice is even more important, perhaps, for mid-level career women.

Van:  What about your advice for women who have achieved some level of success?

Laurie: I think women who have achieved some level of success, just like you, Van, should do exactly what you do, which is you advocate for others. You are very generous with your time in mentoring other women, giving back, and helping and being supportive. I find more and more women who are doing that, and it’s needed and it’s helpful. I don’t think that I’ve ever said “no” to somebody who’s asked for a few minutes of my time to run an idea by me or get a little bit of advice. I think that there are plenty of women who are willing to do that for others. Building those types of communities is extremely helpful. I value them. I’ve appreciated just working with you and getting to know you. I know that that’s something that’s very important to how you show up as a leader.

Van: Likewise, Laurie. Well, there you have it. We learned so much from speaking with Laurie, who is a very successful and a very generous human being. Thank you, Laurie, for being with us today.

Laurie: Thank you, Van. This was terrific.

Van: I’m Van Ton-Quinlivan with Futuro Health. Thanks for checking out this episode of WorkforceRx. I hope you will join us again as we continue to explore how to create a future-focused workforce in America.