SGO Issues September 24, 2015
SGO addressing physician burnout
SGO taskforce pushes for appropriate payment for endometrial cancer care
SGO releases HPV vaccine PSA
ICD-10-CM Codes webinar on SGO Connect Ed Sept. 30
Gynecologic Oncology Advanced Practice Provider Survey
Registration and housing open for 2016 SGO Winter Meeting
By Jeffrey Fowler, MD; Andrew Berchuck, MD and Bobbie Gostout, MD
The largest and most comprehensive study on burnout in gynecologic oncologists, “Burnout and associated factors among members of the Society of Gynecologic Oncology,” was published online in the American Journal of Obstetrics & Gynecology in July 2015 after being presented at the 2014 Annual Meeting on Women’s Cancer in Tampa, FL. In this study of SGO candidate and full members, 32% of gynecologic oncologists scored above clinical cut-offs indicating burnout.
Burnout is a prolonged response to chronic emotional and interpersonal stressors on the job. It is prevalent in the caring professions and endemic in physicians. Burnout is specific to the work context, and is not equivalent to stress or depression. “Progression to Burnout” has been described in 30-60% of physicians and correlates with worsening indices of work and personal well-being.
Risk factors for burnout include younger age, female gender, work hours, type of practice setting and specialty. Burnout is associated with a significantly higher incidence of anxiety, depression, substance abuse, depression, low quality of life, medical errors, low career satisfaction, job migration and early retirement. It not only affects the individual but is also correlated with decreased patient satisfaction and can destabilize a practice group, department and/or health care system.
While unacceptably high, a 32% incidence of burnout is amongst the lowest, compared to the other medical and surgical sub-specialties as reported in the literature. Gynecologic oncology is quite demanding and we are prone to emotional exhaustion. Interestingly, the incidence of depersonalization in SGO members, which is the marker for detachment from the job and treating the patient as an object, is much lower as compared to virtually every other medical and surgical specialty. Perhaps these findings, plus the extremely high level of career satisfaction reported by our members, is influenced by the unique comprehensive continuity of care model of gynecologic oncology and the high-quality long-term relationships that we have with our patients.
Burnout in gynecologic oncologists is and will be a significant problem affecting personal and patient well-being. While the causes of burnout are multi-factorial, evidence suggests that this problem begins as early as medical school and residency training. Women, the gender at higher risk for burnout, will soon make up the majority of our sub-specialty.
The SGO Wellness Taskforce was formed in 2014 in response to the needs identified in the organizational survey. Stress, burnout and low satisfaction with work-life balance is associated with reduction in professional work hours and early retirement. This is problematic in view of the predicted oncology workforce shortage in the coming years. The American College of Surgeons and other professional organizations have recognized the urgency of this issue and are also working to address it. There was an enthusiastic response from the membership, and all who volunteered were asked to join the SGO Wellness Taskforce. Our work is now well underway.
Invited speakers have delivered presentations at the past two SGO Annual Meetings related to stress and burn out. They have included Amit Sood, MD, from the Mayo Clinic, author of “The Mayo Clinic Guide to Stress Free Living”, and Kell Julliard, MA, from Lutheran Medical Center in Brooklyn, NY, who gave a presentation, “Reinvigorating the Joy and Compassion in your Practice.” The Wellness Taskforce leaders also gave a presentation at the fellow and candidate meeting in Chicago earlier this year.
A number of other initiatives are under development. They include an SGO paper to be submitted to Gynecologic Oncology that will summarize the scope and understanding of the problem. We are also planning additional courses and presentations for the next several SGO Annual Meetings. These will increasingly focus on approaches that incorporate principles of healthy living, towards the goal of leading more balanced lives and avoiding burnout.
Stress and burnout are endemic in our society beyond the medical profession, and a number of resources and approaches are becoming available that could be of value to the SGO membership. Stay tuned for more developments as we lead up to Dr. Jeffrey Fowler’s term as SGO President in 2016-2017.
On Sept. 11, the SGO Coding and Reimbursement Taskforce and the SGO Taskforce on Physician Payment Reform met with leaders at CMS to discuss present reimbursement rates and potential future alternative payment models for the treatment of endometrial cancer.
Currently the SGO Taskforce on Physician Payment Reform is analyzing perioperative service utilization for women with newly diagnosed endometrial cancer. Using data pulled from Medicare, private insurance claims, the SGO Clinical Outcomes Registry (SGO COR), and other national data sources, the taskforce aims to develop and test a model that accounts for all phases of endometrial cancer care: Preoperative, intraoperative, postoperative, adjuvant therapy and survivorship.
Every year the AMA/Specialty Society Relative Value Scale Update Committee (RUC) makes recommendations regarding new and revised physician services to CMS, and the average amount of time spent performing a task described by a specific CPT code can vary based on the source material.
SGO proposes working with CMS to fix fee-for-service (FFS) payment rates. This includes using real-life data in validating FFS payments, and using SGO COR and OR log data to set Alternative Payment Model (APM) payment rates.
SGO has also asked CMS to collaborate with the Physician Payment Reform Taskforce in order to mutually partner with experts to refine and validate the payment model. This would involve applying strategies to accommodate both medical and surgical management of patients. SGO seeks first to pilot the model and then, apply it to clinical practice.
“CMS has expressed an interest in using external data to set Relative Value Units for Medicare reimbursement, but they need to be able to do it for the entire fee schedule to get it relative,” said Emily Ko, MD, Chair of the Taskforce on the Future of Physician Payment Reform. “It will be important for us to demonstrate a substantial variation between current care and optimal care, so we can identify the opportunities for value—better quality and lower costs.”
SGO has produced a two-minute public service announcement (PSA) about the important role that the human papillomavirus (HPV) vaccine plays in preventing cancer. The video will be shown in the First Class and Business Class sections of American Airlines flights during the months of October and November. The video also appears on SGO’s HPV resources page at sgo.org/HPV. Members are encouraged to share the video link via social media using the hashtags #HPV and #Vaccineswork.
Part two of SGO Connect Ed’s two-part coding webinar on ICD-10 coding, “The Storm is Here: ICD-10-CM Codes and Case Studies for GYN Oncology,” is scheduled for Sept. 30 at 7 p.m. ET/6 p.m. CT. Hosted by coding expert Brad Hart, this 90-minute webinar includes case studies submitted by gynecologic oncologists. The cost is $150 for members, $175 for non-members.
As the face of the health care delivery system evolves, women’s cancer care will increasingly depend upon Advanced Practice Providers to better meet the needs of patients and their families. In anticipation of this change, SGO is conducting its second Gynecologic Oncology Advanced Practice Provider Survey.
Information gathered from this survey will help identify key Advanced Practice Providers functions and roles in gynecologic oncology and assist in articulating how Advanced Practice Providers can improve current practice models. SGO requests that all members expand the potential survey population by forwarding the survey link to Advanced Practice Providers–nurse practitioners, physician assistants and clinical nurse specialists—within their practice setting.
Registration and housing are now open for the 21st Annual SGO Winter Meeting, to be held Feb. 11-13, 2016, at the Resort at Squaw Creek in Lake Tahoe, CA. This meeting is geared towards gynecologic oncologists and other health care professionals involved in the care of patients with gynecologic cancers. Young investigators are also invited to submit research by Nov. 9, 2015, for consideration for presentation in a special Poster Session.