It’s time for physicians to be less “productive”

Physician compensation in most employed positions is based on how much a physician “produces.” I work as a psychiatrist, and this amounts to how many patients you see per hour. The more patients you see, the more “productive” you are, the more money you generate, the more valued you are by your organization and the more RVUs you churn out for a larger paycheck. But, in human terms, what exactly are you “producing?”

When you see more patients in less time, the encounter is rushed, and there is little time for exploration of patient goals, symptomatology, psychosocial information or psychotherapy. It’s a good way to create problems instead of solve them. So many patients come to me with inaccurate psychiatric diagnoses and overmedication. The time was never taken to explore that their anxiety and depression is the result of an abusive relationship, substance abuse, an unresolved loss or past trauma. They were simply assigned a label and medicated. A new problem was created instead of healed.

In monetary terms, I am a very “unproductive” physician. I take more time to see patients, often double the standard time. For example, a 40-year-old man comes to me spending years in the mental health system on multiple psychotropics with little improvement. He is on mental health disability and living with his parents. When I take the time with him I learn he is alcohol dependent, his goal is independence and he is seeing some early benefit from ACT therapy where other therapies have failed. With even more time and RVUs down the drain he enters substance abuse treatment, gets sober, gets off of several psychiatric medications, cleans up his diet, loses thirty pounds and drops some blood pressure medication. You can imagine the costs saved in this scenario, but I’m certainly not seeing them reflected in my production measures. Despite our treatment being extremely productive, my “productivity” says otherwise. This is one example among many.

Practicing mental health can be incredibly gratifying when done correctly, combining medications only when necessary with psychotherapy. Unfortunately, our system is set up to harm patients and physicians. Patients don’t get good care, they are over diagnosed and over medicated and physicians are incentivized to be more “productive” which is demoralizing. We are treated as if we are commodities without any regard for our humanity. For this reason, I do not recommend medical students enter the field. It pains me to see online forums with residents and medical students espousing how much money they can make in the field seeing 5 to 6 patients per hour. The future does not look good unless something drastically changes. Some will suggest opening your own practice to escape, but this ignores the larger problem. And besides, health care systems are where the majority of people get their health care. I like working in a health care system, collaborating with other physicians, and feeling a part of a team.

I am speaking for my field, but I can only imagine my experience reflects that of primary care physicians who are delivering the majority of mental health care. I see headlines reflecting physician dissatisfaction daily, and trust in physicians has certainly gone down. With good reason considering the rushed manner in which we are pressured to work. Much of our care is relationship based, and time is currency in a relationship. People will argue that we must see more patients to meet demands, but I expect that, with good care, more healing will occur and there will be less “patients” to see.

Physicians are intelligent, driven, and resourceful. We have to be, or we wouldn’t have made it to where we are. So why are we such victims to health administrators, CEOs, and insurance companies? Without us, nothing works; we hold the cards. It’s time we come together, rise up, and take back this system.

The author is an anonymous physician.

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