November 7, 2023

Doctors Making a Difference: Craig Riley, MD

For Craig Riley, MD, changing the way primary care is delivered and tackling the ever-increasing problem of burnout among primary care physicians go hand in hand. As a physician leader-Dr. Riley is medical director of population health and medical education at Vancouver Clinic and program director for the Legacy Salmon Creek internal medicine residency-he's working to push his organizations beyond simple solutions to burnout by urging them to both change how they do business and work to foster purpose and meaning for primary care physicians. He talks to WSMA Reports about the sea change that's needed to address burnout at its root.

WSMA Reports: In your view, why is burnout so prevalent in primary care?

Dr. Riley: Quite simply, the Medicare physician fee schedule does not prioritize primary care and leaves primary care clinicians feeling undervalued. This is the most important job in America from a health and cost perspective (with a growing projected shortage), but a tiny fraction of our brightest medical school graduates is even considering it. Even as a program director of a primary care-focused internal medicine residency, incentivizing graduates to enter primary care is a constantly evolving exercise in creative problem-solving.

All of the well-documented post- pandemic drivers of burnout are only magnified in primary care. Emotional exhaustion and depersonalization naturally deepen where vaccines are administered and patients' anti-science attitudes are openly expressed. Short-staffing affects primary care medical assistants and nurses first, as they often choose less burdensome or better-compensated roles instead. Career satisfaction lessens as primary care physicians are expected to take on more value-based care box- checking and electronic medical record landscaping, often using more family and personal time to do so. Work-life integration is sacrificed, and professional fulfilment becomes career resentment.

Are there ways you're working in your position at Vancouver Clinic to address burnout and well-being among primary care physicians?

Given the expectation that health care continues to achieve improved outcomes with fewer resources year over year, the only way to solve this problem is for organizations to take on more financial risk and move aggressively away from fee-for- service reimbursement. At the least, this aligns patient complexity with resources and encourages innovative delivery models. At Vancouver Clinic, we have incorporated Lean-based thinking and experimentation to innovate low-, medium-, and high- throughput primary care delivery models, engaging clinician brilliance to most effectively approximate the Quadruple Aim. We have also incorporated advanced practice clinicians in creative ways and tackled the in basket from all angles. The result is principle-aligned workflows, improved EMR integration, better compensation, collaborative team-based care, and hope that there is a better way.

What solutions have you found the most impactful for physicians to stave off burnout?

Purpose is key, and one size does not fit all. Many of my colleagues and I find deep, meaningful purpose primarily in education. I have also found work diversity (education, leadership, quality improvement, and multiple clinical domains) can keep work engaging and fresh. Others thrive in an all-clinical environment but feel most fulfilled with more procedural work, certain disease categories, or care for specific populations. And interprofessional team-based care models that thoughtfully incorporate advanced practice clinicians to grow, thrive, and work at the top of their degrees promote a communal purpose. Work opportunities, clinical and otherwise, tailored to a clinician's sense of purpose will always improve professional fulfilment.

For other health care leaders, what are some ways they can begin to address burnout among the physicians they lead?

There are no simple solutions; short-term strategies consistently fail. Investments in value-based care, quality improvement, and education are costly. However, the consequences of continuing unabated on the fee-for-service treadmill, with rising clinician burnout in the post-pandemic age, can be measured by staff turnover, clinician turnover, reduced clinical quality, more wasteful costly care, and reduced work effort. Health care leaders must prioritize not just minor adjustments in staffing ratios, time off, or the occasional free lunch, but invest in the wholesale transformation of primary care.

This article was featured in the November/December 2023 issue of WSMA Reports, WSMA's print magazine.