Of the myriad of proposals meant to change the health care system, including switching to electronic records, paying for performance, and adhering to evidence-based standards, very little attention is being paid to how they will be implemented, and the unintended consequences that may arise.
Annie Brewster, an urgent care provider in Boston, outlines this in a nice commentary: “Reform should make my job more, not less, satisfying. Of course, doctors should be expected to offer the highest quality care in the most cost-effective manner, but policies must be built on a foundation of trust in physician motivation and competency. Most physicians have a sound knowledge base, and are driven by a genuine desire to take care of people and ‘do no harm.’ Professional autonomy must be protected. Instead of imposing mandates and restrictions from above like an authoritarian parent, policy makers should work to provide physicians with the tools to meet these expectations.”
She goes on the cite the problem of converting to digital records as an example. Although the intent is good, often times the systems don’t have a user interface friendly enough to make a doctor’s job easier. As Dr. Brewster correctly notes, “documenting electronically often takes more time than writing in a paper chart, [and] patient portals that allow for email communication with one’s doctor, while clearly beneficial to patients, can often feel burdensome to doctors-just one more thing to check in an already unbearably busy schedule, and extra time for which we are not compensated.”
Reform needs make physician satisfaction an explicitly stated goal. None of the changes will be widely implemented if they are met by grumbling resistance by doctors and nurses. Mandating them will only cause more doctors to leave the field already beset by access problems. And when that happens, who will patients, already waiting months to see a doctor, turn to?
Related posts:
- How health care reform can improve public health
- How teamwork can improve patient care
- How to get doctors to embrace health care reform
- Physician payment reform is the key to fixing the health care system
- Health reform ignores primary care doctors at its own peril
- Improve primary care access before guaranteeing universal health coverage, my address at the National Press Club
- Successful health reform requires changing physician incentives, my take in The New York Times
{ 6 comments… read them below or add one }
Regrettably, the health care reform efforts do little to enhance our professional satisfaction. They were never designed to do so. I’m skeptical that the ‘reformers’ will accomplish even their stated missions – controlling costs, extending access to the uninsured and increasing medical quality. Will they hit a trifecta or strike out? The odds for success are long.
What Dr. Kirsch said. The “reformers” do not care at all about physicians or their job satisfaction. We’re only here to help them buy votes.
Two or three well-placed phone calls from the Feds eleven years ago – enforcing their own rules – would have been all took for me to have a markedly different professional life/experience.
Indeed, that’s pretty much all it would take now: Along the lines of, “Fix it or go to jail”: http://drjshousecalls.blogspot.com/2009/10/exhausting-all-possibilities-coolly.html
These people don’t really care about doctors. We’re cogs on their wheel. Get used to it.
And dream on.
one of the main purposes of reform is to control physician behavior through guidelines, P4P, “evidence based medicine” etc.
So good luck with job satisfaction when you’ll be increasingly expected to follow protocols (and dinged when you don’t) rather than thinking independently about a patient.
What all of the above said. Doctors’ professional satisfaction is irrelevant to decision makers. This might change in the future as the PCP shortage really starts to bite in a big way in this country. It is also possible that we might see even further frantic and counterproductive measures that worsen our satisfaction and worsen the PCP shortage. Never underestimate the stupidity of our overlords.
EHRs and email are absolutely wonderful ideas unless you happen to be a doctor who actually has to use them –after office hours when you would be at home with your family if not for the EHRs and email.
Fortunately there are programs and studies that show that there are ways to significantly improve the primary care physicians’ income and amount of time to spend with patients. For instance, the American Academy of Family Physicians’ TransforMed program demonstrated that physicians in programs assisted to achieve the goals of TransforMed saw average income rise 14%. I spoke to one the physicians in this program and he stated that all of the physicians at the office now have significantly more time to spend with patients.
I wrote about this in my July newsletter and similar results in my July newsletter.
The reformers are all lawyers and have no interest what-so-ever in improving the quality of physician working conditions and satisfaction. In fact, Pete Stark (D-California) has been quoted: ” I want to make sure no mother will ever want her child to become a doctor”.