Should older doctors be allowed to opt out of EMR?

A fair amount has been written on EMR for the individual physician facing retirement.

But I have come across a more complicated variation of the question.  What if a multi-physician group has one physician approaching retirement who is the “lone hold-out,” opposing EMR while the rest of the docs in the group are ready to take the plunge?

The older physician has a point.  The EMR implementation will likely require a large capital expenditure, reducing the value of the practice in the short term and adversely affecting the value of his retirement buy out.  The doc nearing retirement age may have difficulty with the IT skills necessary to master EMR and may not be practicing long enough into the future to see the long term return on the investment required to get those IT skills.

The older physician in this scenario may ask to opt out of the expenses of the EMR project when his income is calculated and to have his retirement buy out calculated without the EMR liability figured in.

That might sound like a good way to resolve a difficult dilemma … unless you understand the physician personality.  The problem is that we docs love our work too much.  That is partly why Medicare, Medicaid and private managed care providers have been able to sharply reduce our payments over the past 15-20 years, and we just keep showing up for work.  As a rule we don’t face retirement well.  Many of us never retire; we just die with our boots (or scrubs) on.

So the older doc who claims to be ready to retire may not retire as soon as he thinks.  So do you let him opt out of EMR or not?

I would be happy to let him opt out of EMRprovided he commits in writing to a retirement date and allows the practice to begin making plans to recruit a replacement physician.  The date would be fairly soon, no more than 18 months in the future.  If he fails to retire by that date he would begin incurring costs related to EMR, both in take-home pay and retirement buy out.

This approach avoids the nearly impossible task of trying to calculate the return on investment “break-even point” for an EMR purchase, as many authors try to do.

Mike Koriwchak is an otolaryngologist who blogs at the Wired EMR Practice.

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