Dr. Jason Sugar, Lead Gastroenterologist at Modernizing Medicine, joined us to discuss physician burnout: what is it, how do you prevent it, what are some of the symptoms along the way, and make sure you have practices in place to streamline your practice to make sure you are not burned out by the time you get home. 

WeInfuse podcast

Transcript: How to Prevent Physician Burnout

Dylan McCabe: We Infuse podcast, episode number 41. Welcome to the We Infuse podcast. My name is Dylan McCabe. And in every episode, we give you a seat at the table as we talk with Infusion Center owners and operators and industry experts so that you can get the insights you need to take your practice to the next level. Now, in this episode, I talk with Dr. Jason Sugar. He’s a chief medical officer at Washington Gastroenterology. It’s one of the largest. gastroenterology practices in the Northwest. He’s also the lead gastroenterologist with modernizing medicine, which is a platform that is specialty specific for EHR EMR systems. And we’re going to talk about that. But the biggest thing we’re going to talk about is physician burnout. We’re going to talk about, what is it, how do you prevent it? What are some of the symptoms along the way, and then how to make sure you’ve got the processes and, the streamlined systems in place to streamline your practice. To make sure you’re not burned out by the time you get home. We’re going to talk about that and much more in this episode with Dr. Jason sugar. Let’s get right into it. All right. As I mentioned, we have special guests on the show today, Dr. Sugar for modernizing medicine and Dr. Sugar. Thank you for joining the show today. Thanks for having me. I’m looking forward to this because we are going to talk about something that I think flies under the radar a lot, which is physician burnout. We’re going to discuss that. We’re going to talk about some of the symptoms issues, why that happens, and then we’re going to get into ways to use technology to streamline things so that physician burnout is, has a much lower frequency among. Among leaders and practices that are implementing the right processes and steps to take the place of some of those things that really stress you out. So we’re going to get into that modernizing medicine as well. And, and talk about those things that any infusion center owner operator would really benefit from. So before we get into all of that, let’s just talk about your background. Who are you and how did you get involved with modernizing

Jason Sugar: medicine? Sure. So, I’ve been with modernizing medicine since 2019. I’m the lead gastroenterologist for them. prior to that, I was on their physician advisory board as well. And so I’ve been a longtime user of their software since dating back to about 2014. and my clinical background is I’m the chief medical officer for Washington gastroenterology, which is the largest single specialty GI practice in the Pacific Northwest. So long time user of the software and then I jumped onto their advisory board. and then they hired me on part time to work with practices, product development and things like that. So practice engagement, all those things. So I do a little bit of everything with them So but they are known for being a single specialty kind of physician driven electronic medical record which is somewhat unique among Electronic, healthcare, record systems and that they actually have physicians who code the software the product I’m not a coder. I’m not good enough to be a coder. I do more patient outreach, but most of the physicians actually code the software. And the reason that’s important is because you have doctors who understand workflows. writing the software. So I think that is a very clear benefit to what we offer.

Dylan McCabe: Yeah, that’s huge. we used to say when I was an account executive with we infuse, I used to, if I was talking to infusion nurses, that was how I sold it saying, Hey, we, collaborated with infusion nurses and basically said, what would the ideal infusion nurses note look like if you were the one designing it? And when you do that, when you’ve got physicians coding, A software platform and they know who the end user is better than anybody else. Other physicians and practitioners, nurses, et cetera. It’s going to be one of the best available. So I think that’s, obviously something that sets you guys way apart. and then with the using that technology to help and aid those practices, what would you say was the thing that, there’s lots of EHRs, EMRs out there. You’ve got actual physicians helping with the coding, but what would you say as Worked with all these different practices and patients, what would you say are some of the, one or two biggest pain points that you’ve seen in these practices that modernizing medicine helps with?

Jason Sugar: Well, I think, two of the things are directly the bread and butter of what, modernizing medicine does. And one is, that it’s a fully integrated product. In other words. On the old system, you would have a practice management system. You would have an electronic medical record system. You would have an ambulatory surgery center system. You would have a billing and coding system. You’d have a messaging app. You’d have a billing app on your phone. And what modernizing medicine does is it takes all of those things and it puts them into one software program. So everybody in the practice is working in one program all the time. You communicate with each other within the program. And then, And it’s just very efficient because otherwise you’re working through five or six different applications trying to schedule a patient do a procedure report, perform revenue cycle management, it’s just very inefficient for the staff and it requires a lot of extra work when you’re in one system. It’s all right there for you. So it’s very efficient. And the other thing that’s, I think, unique about modernizing medicine is we don’t have one software program. We have a bunch of different ones and they’re specialty specific. So I’m not in the urology module, I’m in the GI module. And so each one of those different platforms has its own specialty driven solutions. So because it’s very different. So when you look at if you think about let’s just use epic as an example, it’s a great program for the hospital, but you’ve got 30 different specialties working on that. It’s not specialty specific. This is a very efficient focused program for each of those specialties. So I think that’s key.

Dylan McCabe: That’s right. That’s such an essential point because we used to, again, when I was selling we infused, I remember we were, calling on one of the largest infusion practices in the U S and at the time I believe they were using next gen. But anyway, I went on the either next year or one of the other big EMR systems website. And I did a search in their search. on the website for the word infusion and nothing showed up. And so that was one of the first slides on my presentation to them that you’ve got this broad platform that’s meant to apply to everybody, but you are so niche. And so it’s great that you guys have done that to me. there is no one size fits all, when you have a specialty practice. So, so that’s great. So let’s, get into that though. You, mentioned a few things about streamlining, not having multiple tools. not having multiple balls in the air that you have to juggle. one of the things we mentioned was physician burnout. Let’s talk about that. what is physician burnout? how prevalent is it? We’re going, let’s dig into this a little

Jason Sugar: bit. Sure. So, it’s very prevalent. And if you think about GI, if you look at the studies that they’ve done, maybe 44 or 45 percent of G. I. Physicians have experienced it and that’s on the low side for physicians. So G. I. Does actually pretty well. but still that’s a significant portion. And so burnout, can mean a variety of things to people. But the key things you’re thinking about her, physical and emotional exhaustion. Depersonalization, cynicism, a lack of efficiency, a lack of joy in what you do. it’s just a feeling of being run down by the mundane tasks of medicine that most of us didn’t go into practice thinking that we would be spending time doing. So, it is important and, it’s increased and, we just need to acknowledge that and, do what we can from a technology standpoint. to, minimize that to the degree that we possibly can because a lot of time we’re spending working on administrative tasks, administrative functions, insurance functions. That’s not what most of us want to medical school, right? We want to take care of patients and that’s what we want to spend the majority of our time on. So anything that we can do to decrease that administrative burden, automate our practice. all of that will at least cut into that physician burnout to a certain extent.

Dylan McCabe: So why is it happening though? when you go to, when you go to medical school, like you said, do they teach any courses on, Hey, here’s a leadership course that you need to consider as you’re leading your practice or, Hey, here’s an emotional health course, right? Or is it all, I haven’t been to medical school, obviously. What, is there anything that speaks to this before you get into the scenario?

Jason Sugar: Certainly not when I went to school. So I graduated from medical school in 2002. so I think they are starting to slowly add some of these things in, but to your point, when I graduated medical school and even when I finished my residency and fellowship, I didn’t know how to bill for a patient. I didn’t know how to, do an authorization for insurance. we, just didn’t have any training for that. So I, do think my understanding is, that as we progressed medical school residency fellowship is trying to incorporate some of that, but it certainly is not, Okay. The primary focus. That’s for sure.

Dylan McCabe: that’s interesting. It’s there’s such a big gap in skills and knowledge between a medical physician who’s going to see gastro, whatever patients, rheumatologist, whatever. There’s such a big gap there in the skill set needed and the skill set needed to be an effective CEO. Yeah, it’s totally different or an effective executive. So you think that, and like you said, they’re maybe starting to do some of that now. I assume there’s really going to be a growing trend in that direction to equip men and women to do their job well, because if you’re weighed down and stressed out by all of these things that you, really weren’t passionate about or didn’t want to get involved in, and that stuff takes up a large chunk of your mental space, that’s, going to be rough. So once it starts, Once you start to experience that stress, maybe a little discouragement, some confusion, and that starts to eat at your mental strength, your physical strength, your emotional health. What are some of the symptoms that, that people can experience as they’re starting to go through that journey?

Jason Sugar: Yeah, I think, physically people have, potentially fatigue, headache. A lot of times they’ll just start to not enjoy what they’re doing very much. maybe their attitude is not as good as it could be. Their outlook is not as positive as it could be. and so I think the main thing is to just recognize that’s what’s happening more than anything else. and then to deal with that, there’s no magic bullet for physician burnout, but. Certainly having tools to make your practice life easier, having support staff to perform administrative functions, setting aside time for yourself, for your family, for exercise, for leisure activities. just trying to, better diet. just trying to live a healthier life can help. but there is a lot that goes into it. And, we’re not gonna be able to snap our fingers and make all that insurance paperwork go away overnight. That just doesn’t happen. So there’s not a one size fits all solution for it.

Dylan McCabe: That’s good. I have an undergrad degree in organizational leadership and one of the things that they taught about, avoiding burnout was having accountability partners with other leaders who could shoot straight with you and say, Hey, how’s it going? How’s your head space? if you were to take inventory over your, of your thoughts over the last week or two, have they been more positive or more negative or somewhere in between? And, that was one of the key things they taught us surround yourself with at least one or two other leaders that you can speak to candidly, who you also admire, and you can talk freely about what you’re going through as leaders, and even share some of the negative stuff that, I’ll tell you the truth. I’m, really unhappy. I had two extra drinks at dinner last night. It’s, getting a little stressful. I’m just, I’m starting to, just as soon as I get home, I want to turn on the TV and watch it until we go to bed, sharing those things so that it’s not six months in, you’re finally sharing with somebody or two years in you’re sharing with somebody, I’ve gotten to the point to where. I, it makes me anxious to think about not having a drink at night. that’s, when the alarm bells should be going off. And I think if you’ve got people close to you, if you’ve got some community of other leaders, even if it’s to others, that could be a big barrier to preventing long term burnout journey.

Jason Sugar: Yep. That’s true. And clearly, most practices aren’t set up to have that kind of. Formalized function. It’s all very informal, right? So we don’t, we’re not taught that in school. We don’t have classes that we take. So a lot of it’s just informal camaraderie, informal, communication, things like that. But we definitely have to do a better job with it. That’s for sure. That’s certainly true.

Dylan McCabe: So what else you mentioned? So having some people you can talk to community, you also mentioned balance. What does that look like for a physician? I feel like the average person, whether it’s an attorney or any business executive, they look at healthcare professionals in a different light. It’s like, that’s the dream job. Yeah. You have to go to a lot of, you’ve got schooling on the front end and costs associated with that. But once you’re in there, you’ve just got got the dream job. So what does balance look like in your eyes to the typical healthcare professional?

Jason Sugar: balance. I think, it can be hard to separate work from your life. Right. So I think being able to do your work efficiently so that when you come home, you don’t necessarily have to sit at your computer for two hours every night and do more work. Right. That’s, a big part of it. And then a lot of it’s just, being healthy, finding time for exercise, you have to eat healthy, not drink too much, obviously substance abuse is a problem and, society at large and, Certainly that’s true for physicians as well. So not, so dealing with that. but having leisure time, you have to spend time with your family. You have to spend time at the dinner table, right? You have to spend time relaxing. So there has to be time for that carved out in your life where not all you’re doing is working all day, coming home, working some more, going on call and working the weekend. So you have to carve out time. And you just have to be deliberate and intentional about that.

Dylan McCabe: I think that’s a great point. We, one of the things we talk about in our other, leadership organizations I’m in is you to have a good leadership compass. you’ve got, if you’re going to use a compass to take you anywhere, you’ve got your North, South and East and West. And one of the things we always talk about is North true North is character. You’ve got to make sure your character solid, that you’re, not, you don’t have some hidden things in your life that people would be shocked to find out about. Like we read about in the tabloids. And then east is your vision, your planning ability, strategic planning, annual goals, 90 day goals, et cetera. a lot of the things we talk about on this podcast are the skills needed. but west is those relationships and you, spoke to that repeatedly time with your family and making sure that your relationships are healthy. But I think one of the things you’ve, mentioned is Efficiency and you really can’t free yourself up mentally to focus on your relationships. If you’ve still got work on your mind, when you come home, if you can’t leave it there, knowing things are handled, I’ve got the right people in the right seats. I’ve got solid processes in place. The train’s going to keep moving when I leave. Things are good. So let’s talk about that. Let’s talk about, some of the key things that are needed for efficiency. What would you say is one of the biggest things somebody can do to increase efficiency in their practice?

Jason Sugar: So, what you don’t want to do is have staff on the phone all day in mailing letters, licking stamps, things like that. you don’t want to be spending all of your time filling out, insurance requisitions, prior authorizations. I think infusion is a good example because if you think about it, the first step is for infusion is, does the patient need that medication, but doctors, we think we can handle that part, but you can’t just say that patient’s going on Remicade tomorrow and then it magically happens. you have to talk to the patient, you have to do your visit, you have to talk to them about the risks and benefits, but then you’ve got to start the grind of actually getting that medication approved by insurance. And so having a dedicated staff who knows how to submit those forms, having a dedicated staff who understands patient assistance, because right, all these drugs are very expensive. And patients, they may have insurance, but their copay is gigantic. So their insurance may cover Remicade, but that doesn’t mean that they’re going to be able to afford getting it. So having staff who have kind of siloed tasks where they understand they’re doing the same thing. So you’re not having 10 different people trying to submit a prior authorization for a drug. Having someone who that’s their specialty, that’s what they’re dealing with. They understand how to submit the paperwork. They know to call the patient. They’re in communication with them. They understand all the, the benefits that they can get if they’re having trouble paying for it. So having dedicated staff for very specific tasks, as opposed to having a nurse who’s checking in a patient, then sending in a prescription, then taking vitals, then filling out a form, and then trying to figure out how to get a patient to be able to afford their Remicade. That’s not efficient at all. Whereas if you have staff doing specific siloed tasks, that’s much more efficient and they get better at it Right, so they become the go to person to submit authorization to insurance companies and when something happens and as you know It always does They know the workarounds, they know who to call to get it fixed. And so that’s a very efficient way, as opposed to me trying to fill out paperwork that I probably don’t understand and I’m not going to do correctly because I haven’t been trained how to do it. So having dedicated staff who are properly trained for a specific task is really important in terms of having an efficient practice.

Dylan McCabe: That’s so good. one of the things we talk about is having the right people in the right seats and the right people are those who align with your mission and your core values and right seat means you’ve got them in a role that they are uniquely designed for. And they get it, they want it, and they have the capacity to do it. And capacity, I think, is what you’re speaking to a lot is you don’t have the capacity to do everything well. You got to develop a team around you that can take the ball and run with it. And somebody who’s uniquely wired to do things better than you are. like you said, if you, go to medical school and your passion is really helping patients, you probably aren’t good at repeated processes over and over again on the administrative side. And nobody’s good at everything. So I think that’s great. and that’s just a challenge to anybody listening to this, everybody should have some sort of organizational chart where you have key roles in every area of your business and you’ve got the right people in those roles. So that’s, great. What, else is something somebody can do? Like how would modernizing medicine help them with these efficiencies?

Jason Sugar: Yeah. So there are a lot of things that you want built into your software and this goes for any HR, but I think we do it pretty well is you want to have technology that takes time and gives it back to the staff to do what they need to do. So you want to be able to have that nurse go and take care of that patient, check them in, give them the Remicade infusion, perform procedures in the ASC. What you don’t want to do is have them sitting on the phone all day. mailing letters, calling patients, having them call back. So for example, recalls is a great example of, so when you do a procedure, when does that patient know that they have to come back for their next colonoscopy? Right? So you can either have a file or you can hope you remember, or you can put it in a note, or you can have a computer system that automatically sends them a letter when they’re due. And that is great, right? That takes a lot of work out of your staff and you don’t even have to worry about it. So when I put an order in the computer saying next colonoscopy 10 years, that means 10 years from now, modernizing medicine, that program is going to send them a reminder. They’re going to send them a letter or a text or who knows what we’ll be doing in 10 years. Right. But they’ll be getting something. They’ll be getting some communication saying it’s time. As opposed to you never seeing that patient again for 10 years and hoping that their primary care doctor kind of remembers to send them back. Right. So that’s really important.

Dylan McCabe: No, that’s huge. automating that process, you’re freeing up somebody on your team from taking the time to do that, but you’re also ensuring that it happens. And so, so my, making that process automatic, that’s, huge. What would you say is, after seeing, you guys have one of the biggest practices, like you mentioned for G. I. You’ve seen things over and over again that have gone well and have not gone well. What would you say is the number one thing over and over again? That’s really holding physicians back from growing the kind of practice they need.

Jason Sugar: Well, I think it’s what we talked about. It’s having a structure in place. not every, practice is 30, 40 doctors, right? So, it can be a challenge for smaller practices to, to do all those things. Remember, you talk about recalls, you talk about having the bandwidth to check patients in. You can either have that nurse enter everything into the system manually, or you can have a patient portal where the patient has filled out their information and it’s just there. It’s there in my note when I walk into the room. So those kinds of things, the more of those things you can do. the better your practice is going to be running because you’re not going to need so many staff and as you know these days It’s hard to hire, right? it’s just very difficult in this job market to hire So the more things that you can do to automate your practice, the better you’re going to be It’s going to be a smoother running practice. It’s going to be more efficient You’re going to be able to take care of patients quicker So being able to do that on the internet and kind of log on, put your medical history in, that takes a lot of time and gives it back to the nurse. You can then go call back another patient who’s not feeling well, right? So it’s very efficient.

Dylan McCabe: So what would be your advice then to physicians that are out there that are listening to this, especially those that have an infusion practice, and they see that as, they probably saw that as an opportunity to help patients have another business line. But that also brings more complexity, way more complexity, especially from a workflow standpoint and more risk financially, what would be one piece of advice you would give to, GI doctors who have an infusion practice on this particular point?

Jason Sugar: So I think the number one thing is don’t think you can just decide one day you’re going to start an infusion practice and it’s going to go well because there’s a lot involved in that. you think about, we talked about authorizations to even get the patient, the drug, right? So, but you also have to think about, well, the patients in the infusion center and who’s there if there’s an infusion reaction, what’s your protocol for dealing with that? So there’s a lot involved in terms of patient safety and protocols. Do your nurses have the experience to recognize when something is happening that shouldn’t be happening? so there’s a lot that’s involved and you have to think it through, really from the time they hit the door to the time they leave. so just like you have people who are dedicated for obtaining authorization, you want to have nurses who are experienced, and you want to have providers who are experienced, to be in that infusion center or be readily available if there’s an issue that comes up.

Dylan McCabe: Yeah, it’s so, good. You can’t, it’s, we used to, I used to tell people you, you can be very experienced as a physician in your specialty, but starting an infusion practice is almost like starting an entirely new business and you, have to do your due diligence. because there’s so many steps. And of course, the we infuse platform makes it seamless and simple, but there’s still so many critical steps that have to happen. that the risk is not as great with your typical healthcare practice. so what would you, what would be your, Kind of parting piece of advice on the burnout part. If somebody thinks, they may be going through that or they think, yeah, I can identify that with a little bit, what would be your advice to do right now? What’s something they could start doing now? Should they, should, is there a particular forum that’s helpful? Is there a, group? Is there, should they just go to a fellow colleague and say, look, I’m stressed. I’ve had it, let’s do lunch.

Jason Sugar: I think that’s always the best place to start, right? Because chances are you’re not the only person who’s feeling that way. So I think. The first step is really just acknowledging that it’s happening and then probably seeking out your peers, your colleagues, other people in leadership, who can help guide you and find resources for you. But, the biggest challenge is not even acknowledging that it’s happening to you, right? So, step one is, it’s like, it’s a cliche, but it’s acknowledging that there’s a problem, right? And so once you do that, it becomes a lot easier to take action, whatever it is. Maybe it’s, wow, I haven’t worked out in three months. man, I haven’t seen my family, put my kids to bed for two months. I’m just tired all the time. I’m going to bed late. I’m getting up early. I’m taking too much call, just depends on your individual situation. But if I think if you acknowledge it and then talk to your peers, your colleagues and your friends, I think that’s a good first step of what to do.

Dylan McCabe: That’s great. I think if we all could just have a healthy ego, not one that’s overinflated, but also not one that’s totally deflated where you think nothing of yourself and you think you’re a piece of junk, if you’ve got a healthy ego and there’s nothing to prove. it should be easy to share with somebody and open up in a, lighthearted way and say, man, this is getting rough. This is not what I expected. I’m tired, worn out, stressed out. What do you think? How you’ve been doing this for 10 years and I’ve only been in this practice for three, what do you recommend? there, it shouldn’t be some big cataclysmic event to just chat with a fellow colleague about this in a healthy way. So, we just want to challenge everybody to do that. I’m sure there’s going to be people that want to learn more. About modernizing medicine because you have physicians involved in the coding and design of the platform. It’s specialty specific. And for those of you listening, you can go to the website, just do a Google search for modernizing medicine. And you’re going to see this, but the specialties that they really cater to, and you can learn more. So what’s the best way for people to get in touch

Jason Sugar: with you? So probably the best way is my email. And that’s Jason dot sugar at mod med. com. Jason dot

Dylan McCabe: sugar at mod med. com. And, I assume LinkedIn as well. And, like I said, you can Google the website. So this has been helpful. I think we’re talking about something that a lot of people don’t talk about, and it really is your mental, whatever you want to call it, health. Peace of mind, mental toughness, whatever that issue is, where burnout comes into play, it really is married to how efficient your practice is in the business side of your practice. because if that’s sloppy and a bumpy process, you, are never going to have the peace of mind that you want to have. So I’m glad we could speak to that. And, Jason, thank you for being on the show. Great. Thanks for having me. All right. Valuable interview with Dr. Jason Sugar. And when you’re the chief medical officer of a very large, practice like that, you see the same things over and over again. And I’m really glad he could speak to physician burnout and also just streamlining your practice, having an organized practice with the right people doing the right things, really things we all need to hear, but I really hope for those listening to you that are leading healthcare practices and fusion practices that you take note and hope it’s an encouragement to your journey along the way to be a better leader and be somebody who can offer the best care possible to your patients. If you want to learn more about weinfuse or if you haven’t done so already, You definitely need to see how we infuse can save you time and money by streamlining everything on the infusion side of the practice. You’ll be so glad you took a minute to check it out. You can just do a Google search for we infuse, software and you can schedule a no obligation discovery call with one of our account executives. All right guys, this is Dylan McCabe with the we infuse podcast and I will catch you in the next episode.

Guest Speaker: Jason Sugar, MD is the Chief Medical Officer at Washington Gastroenterology and Lead Gastroenterologist at Modernizing Medicine. He received his Doctorate from the University of Chicago Pritzker School of Medicine and is a member of multiple associations, including the American College of Gastroenterology and the American Society of Gastrointestinal Endoscopy.