It should come as no surprise that primary care physicians are looking for careers outside of medicine. That 40 percent of primary care clinicians are concerned their field won’t exist and that 21 percent plan to leave primary care in three years.
Doctor burnout has reached epidemic levels. Primary care physicians feel like mice on a wheel, running faster without gaining ground. If we don’t take steps to turn around this trend, our health care ecosystem is bound to become more fractured, leading to greater care inequities.
COVID-19 is the tipping point, but it is not the cause. This burnout is due to ongoing and growing administrative burdens placed on us by electronic medical records (EMRs), coding and billing requirements, and prior authorizations. And, more recently, exacerbated by mounting uncertainty in the primary care field.
A formula to reduce burnout
Resource-based relative value scale (RBRVS) is an acronym unknown even in some health care circles, yet representative of a payment system nearly every clinician uses today. Launched in 1989 and subsequently adopted in 1992 by Medicare, RBRVS is now the core of U.S. health care.
RBRVS determines prices based on three factors: physician work (54 percent), practice expense (41 percent), and malpractice expense (5 percent), assigning each procedure a relative value based on geographic area. Over time, the relative value of specialist work has climbed much higher than primary care. This uneven compensation, combined with administrative tasks, has led to significant fatigue.
Compounding this is massive COVID-19 uncertainty to changing payments models to new entrants into the primary care space. A wide range of companies and industries are investing in new primary care models, from retail pharmacies to insurers to technology giants and digital health startups. Nearly all are aiming to replace primary care with their own systems, and this ongoing uncertainty is exacerbating physician stress.
But I believe there is a formula that can reduce the risk of burnout and save primary care, rooted in one key objective: Remove work from primary care doctors and nursing staff’s plates immediately.
Easier said than done. And that’s where technology and clinical navigation must be leveraged — to assist, facilitate, streamline, and support. Where EMR messages, not requiring doctor expertise, are responded to by clinical navigators harnessing technology to guide patients to the right outcome. Where these teams of clinical navigators are integrated into the clinical pyramid and delegated all tasks that do not require physician attention.
Integrated technology + navigation = relief.
Benefits will multiply. Patients’ issues are responded to more quickly and conveniently, leading to improved patient satisfaction and outcomes. With it comes a deep sigh of relief for the primary care team and a much smaller list of patient emails needing responses.
What do we risk if we do nothing? Our next dire health public health issue, perhaps in the aftermath of COVID-19, will be dealing with a health care ecosystem that has lost its “hubs” – essential primary care teams that coordinate and guarantee wraparound care for patients.
Ronald Dixon is an internal medicine physician.
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