Founder and CEO Suvas Vajracharya, Ph.D., had the opportunity recently to join Dr. Dianne for an episode of The Doctor’s Life podcast to discuss Lightning Bolt’s AI-based shift scheduling as a solution for preventing physician burnout. Enjoy part two of their conversation below, find part one here, or discover more episodes of The Doctor’s Life on iTunes or Google Play.
Dr. Dianne: We’ve mentioned how that might help physician burnout. I’d like to dig into that a little more deeply. One question that I have is that when you add a new system, you can see where there would be some resistance to that and maybe for a good reason because it’s yet another system that you need to learn. Every time we have a new system come in, new EMR or something, it feels like a burden. One of the things that docs complain about, and for good reason, is that they are spending a lot more time on technology and not as much time with patients, etc. Is this giving docs yet another system to have to work and learn and you know what I’m saying?
Suvas: I completely understand. I would have to admit that people like us, the software guys, have not really helped the burnout situation in terms of introducing user interfaces, especially for EMRs. A cause for burnout is having to use systems that are very difficult to use, a lot of typing and a lot of clicks. I think that EMRs especially… Instead of introducing burnout, it causes burnout. We think of our system as sort of the antidote to that where this is really about helping physicians. It could be new, but the doctors themselves that are on the schedule can use it to the extent that they want. This is really intended for the scheduling administrator who builds the schedule, and so it helps save some time.
The doctors that are on the schedule, there are some that don’t even want to have to look at the schedule on the computer, and that’s fine. They can just get a printout and even can do it on a spreadsheet if that’s their preference.
The majority of our users, the doctors, like the idea of being able to see the schedule on their phone or on our web-based application because, first, you’re guaranteed to be looking at the most current copy of the schedule. The schedule is always changing, doctors swapping and trading. It’s nice to be able to have a central source for the current schedule, and you can get that on your mobile device, etc.
The other reasons that end users like to use our mobile app or web-based application is that if they want to trade shifts with doctors — so this is after the system has already built the schedule — they can easily look at the schedule and ask their colleagues if there is a way for them to broadcast a shift availability. If I can’t be on this call or I can’t take this shift on a certain day, I can take a look to see who might be available that day and send a broadcast. There’s a way for them to, on the receiving end, doctors can just say yes or no to that request for a swap.
It does streamline that. The doctors can also go online to submit vacation requests. It’s helpful when you’re making a vacation request to know who else is gone that day because there are too many doctors out and it may cause a challenge for the scheduler to build a schedule that covers all the shifts. One of the advantages of electronic means of requesting vacation is you can see who else is gone that day. How many colleagues are gone on July 4th weekend? If you see many others that are already gone, you might choose a different week for vacation, etc. It does help end users too. All the rules that we talked about, the scheduling rules, etc., that’s actually only the responsibility of the scheduling administrator, and that’s not exposed to the end users when they log in to see the schedule and maybe make some trades.
Overall, the goal is to keep things very simple for the majority that are on the schedule. Our goal is to not make it more complicated than what they currently have looking at the schedule on paper or spreadsheet.
Dr. Dianne: Right. That makes sense. We’ve talked some about how it’s making things more easy, fair, and equitable, which can contribute to decreasing burnout. We know from the literature that a perceived lack of inequity can contribute to burnout and having more control over your work and your schedule can decrease the amount of physician burnout. Are there specific examples or initiatives that Lightning Bolt Solutions is taking to show that there’s these correlations with the decreases in physician burnout? Do you have any case studies or data to show that what you do really helps docs?
Suvas: Yeah, and I would admit that there’s many causes to physician burnout. I was actually amongst a Commonwealth Club discussion on physician burnout with many panelists, including doctors from UCSF and Bridget Duffy from Vocera, that talked about physician burnout, and it’s a very complex topic. As you had mentioned, one of the causes of burnout is the extent where physicians don’t have control of their working conditions. A recent study by the AMA also pointed out that feeling the lack of control in their working environment was a major cause of burnout, and elsewhere in the Stanford study, one of the results was that lack of control over their own work schedule was a major cause of burnout for doctors.
In a different study from Stanford, they pointed out that physician burnout is having a large financial impact. $7.5 million for just Stanford alone because of not being able to retain doctors. The turnover itself was causing a large cost to their organization. We helped — and this is only one aspect of a very complex topic on physician burnout — how we help is providing schedules that give more flexibility to individual providers, being able to individualize their schedules. One case study is our client iNDIGO Health Partners in Michigan where they started using our system in 2005, and this is the study that they conducted on what was the impact of the Lightning Bolt scheduling system over the three years from 2005 to 2008 that they were using it.
It was really surprising because what they found is that after using Lightning Bolt, their retention rate went up as high as 97.6%. This is a large hospitalist group. At the time of the study, they had 112 providers, and at that time, in 2005, the retention rate among all the hospitalist groups in the nation was 87.6%, and so their retention rate was much higher, and they attributed that to being able to create schedules that were flexible. They had providers where some were only available to work part-time and others that needed to work only certain types of shifts — only day shifts — in some cases, or in other cases they could work for several months and then were gone on leave for several months and then come back. A lot of young doctors want that work-life balance where they’re not always working. It’s very common these days that less doctors work on a regular basis.
How Lightning Bolt helps that effort is that it’s looking for these resources that are available and how do you optimize that available resource. So you can compare this to Uber. When you find a driver to take a ride, there’s a lot of work being done in the background. The Uber driver has the profile on when they can work, maybe they can only work on weekends because they have some other day job that they’re doing at other times.
The Uber application is looking to see the first available driver at the time you need it. It looks up the ones that are available based on their availability profile. The same thing for doctors. We’re trying to see when they’re available. Do they prefer to work the night shifts? Do they prefer to work during weekends? Are they only available to work 20 hours a week? Is it a couple that can only work together on call or they can’t work together on call? Those are all the requirements, and when you add up all these variables, if you try to do this in your head, despite the best intentions from the scheduling administrator, it is not humanly possible to do that in your head. That’s where AI can be helpful, and that’s how we’ve been able to get a very high retention rate for our clients. iNDIGO Health Partners is an example. That’s one benefit.
The other benefit, of course, is just the time to build the schedule. If you’re a scheduling doctor, not only are you burned out from your clinical duties but you can get burned out from doing the schedule.
Dr. Dianne: Right, oh yeah. Especially with the docs who have people coming at you wanting this and wanting that. Yeah, it’s a thankless job for sure. You were saying, I interjected but you were saying it saves the scheduler time as well.
Suvas: Yeah, so the same case study, the group grew from a practice of 40 doctors to 120 doctors in the span of the study from 2005 to 2008. As their group grew, they went from a 40 person group to 80 person group, and their scheduling wasn’t just twice as difficult, it was exponentially more difficult. The doctor that was doing the schedule was getting to the point where the doctor was essentially working full-time building the schedule for the now group of over 100 doctors, and this wasn’t a good use of the time.
Two things happened when they started using Lightning Bolt. One was that they were able to save a great deal of time by having the system build the schedule, but more importantly for them, they were able to hand it off to an admin person. We took all this information about how to build a schedule, a domain expertise that the doctor has acquired over many years of doing the schedule — we talked about it earlier, brain dumping — a brain dump of all the know-how into the system so the rules are now really reflecting how he built the schedule and what he knows. Once that was possible, I want that transferred to the computer system. They felt comfortable handing this over to an admin person because now the goal was to just click on a button and the system would build a schedule and the doctor would still review the schedule before they published it. The system would have done the bulk of the work so it was possible to make the transition to a non-MD admin. That was very useful for them.
Dr. Dianne: Yeah, really useful. So they had good results. I’m, as many companies have and many health groups have, I should say, I’m curious to know the Doctor Leo, who got you rolling with this with your very first puzzle, so to speak, what are they doing now? Are they still in practice?
Suvas: Yeah, they’ve been using this system for over a decade now. At the time, Leo’s group was a group of internal medicine doctors, but since then, they are now part of a larger multi-clinic in Wisconsin; and now it’s been deployed to the entire clinic, so it’s more than just Leo using the system. They’re an example of how the system has been providing value for many years. They are one of our early clients, but we have many other clients that have been using for more than a decade.
Dr. Dianne: Awesome. Well, this has been a really interesting conversation but one that’s a little bit different for The Doctor’s Life. It’s neat to be able to talk about not just things that we can do as individuals to improve our work-life balance but how we can partner with other organizations and other companies that can actually help us. I know that there’s a lot of talk about EMR and how it’s going to make life so much easier, and because of that, as soon as you hear somebody say “technology,” the eyes get rolling. Everybody shuts down. I would say that this: in my view, this is an exception to that rule. Hopefully, EMR will change and become better and more efficient for docs over time. This is one way that technology has actually been shown to help docs. Thanks for creating Lightning Bolt for us.
I like that how you created it organically as a solution to a problem that a real doc actually had. That’s super cool.
Suvas: I just wanted to point out one more thing. A comment about technology. The EMR technology not helping doctors is actually causing issues and causing burnout, and it’s one of the causes of burnout. Technology is not serving the medical community in two ways. One, it really comes down to the government regulations, but the vendors that produce the technology for EMR hasn’t helped. The other way that technology is sort of having a negative impact on the perspective of doctors is that there are all these discussions about artificial intelligence and to go to eventually replace doctors. I personally think that it’s possible to not. Even if it does happen, it’s going to be decades from now, and there’s a lot of people who believe we’ll never be able to do that. I’m in that camp.
In the meantime, the problem today is that there is a shortage of physicians. There’s not enough doctors to see the increasing number of patients, and patients themselves, the type of care that they need is more acute than it’s been in the past with an aging population. We need help now. I’d like to just point out that the focus on AI to replace doctors is not the right direction we should be going in. We should have tools that would help doctors be more efficient and do less admin work, not more admin work as in the case of EMR. Lightning Bolt’s mission is to help physicians have an easier time and have more time to spend clinically and be with patients instead of having to do admin work.
Dr. Dianne: Well said, well said. So glad to have you on our side. We’ve been talking with Suvas Vajracharya today from Lightning Bolt Solutions. Thank you so much for coming on The Doctor’s Life podcast. This has been a really interesting discussion.
Suvas: Thank you, Dianne, for having me.
Dr. Dianne: You’re welcome. For everybody, how can we get ahold of you if we’re wanting to learn more or just chat about AI and EMR?
Suvas: I would be happy to speak with you. The easiest way to know more about Lightning Bolt is to visit our website at lightning-bolt.com. We can schedule a consultation with you to see how we can possibly help you with your scheduling.
Dr. Dianne: Fantastic. Alright, until next time, everybody. I hope you stay happy and healthy. Thank you for coming to another episode of The Doctor’s Life podcast, and we’ll see you really soon. Take care.
Dr. Dianne: Thanks for listening today. If you like what you’ve heard, be sure to hit subscribe in your podcast app so that you won’t miss an episode. You can also read show notes, get links, and contact me by going to drdianne.com. And docs, while you’re there, take the physician vitality assessment, which will help you more clearly see if you are at risk for burnout.
Dianne Ansari-Winn, MD, MPH, is a board-certified anesthesiologist and nationally recognized author, speaker, and coach. Dr. Dianne is known for her powerful and practical coaching, which she shares with her exclusive one-on-one physician clients. She is the host of The Doctor’s Life podcast and is the founder of the Physician Vitality Institute, which has the mission of helping doctors to heal the world through being healthy in mind, body, and spirit. Dr. Dianne is a member of Lightning Bolt’s advisory board.
Catch up on part one of the interview here.
The interview originally aired July 27, 2018 on The Doctor’s Life. The transcript has been lightly edited for clarity.