A perk of Medicare for all: More time for doctors and patients


Health care reform dominated the past three democratic presidential debates: twice as much time was spent as on foreign policy or climate change. Yet discussions of health care financing miss one critical issue that patients and providers desperately care about: sufficient time to communicate with each other.

Presidential candidates focus on cost, policies, and logistics of implementation. But no one talks about how proposed plans will fix a big problem in the doctor’s office: the amount of time doctors must spend attending to the computer – the electronic health record (EHR) – rather than the patient.

Only one plan can give doctors the time they need to examine and communicate with patients: Medicare for all.

Why? Because the EHR is built largely to support complex health insurance billing. And that means doctors spend fully 45 percent of primary care visit time (in the exam room) on EHR tasks.

Every clinic day, for every hour spent face-to-face with patients, physicians spend two hours on the EHR and desk work.

Although the U.S. ranks second of 67 countries on length of primary care visits, right behind Sweden, this is at odds with physician and patient reports of impaired communication during visits. It is almost certainly due to EHR demands. The uptick in primary care visit duration in the U.S. since 2004 corresponds with the uptake of the EHR. Hospital physicians spend less time with patients because of EHR demands; outpatient physicians report that the EHR lowers the quality of their interaction with patients.

With a greatly simplified billing system under Medicare for all, the endless electronic hoops physicians and other health care professionals must jump through will decrease significantly. That means one thing — more time for patients. And that’s not hypothetical. Other countries with less complex billing systems, using EHRs from the same company, have far less cumbersome and time-consuming EHR demands.

Primary care doctors are already in dangerously short supply, suffering from epic rates of burnout, retiring early, contemplating, and often shifting to other careers. It is hard to attract medical school students to the field. By 2025, we will have an estimated shortfall of 52,000 primary care docs. One of the main contributors to many primary care doctors’ plans to cut back on hours or leave the field is dissatisfaction with the EHR. Patient participation is stifled with doctors who mouse click, keystroke, or gaze at the computer.

While some primary care visits require only a few minutes, many patients benefit from longer interactions — especially those who suffer from multiple chronic conditions, have living situations that compromise their ability to lead healthy lives, or have substance use or mental health issues. The majority of physicians report being unable to address social determinants of health due to inadequate time, even though 85 percent recognize the importance of these factors to their patients’ health. With our rapidly aging population and increased income inequality, we need more rather than less time for doctors and patients.

Inadequate consultation time also has financial costs: more unnecessary referrals to specialists, prescriptions, screenings, and interventions.

Wouldn’t it be better if we simply gave our physicians and patients the high-quality time they want and need?

We’d take a huge step toward more time for physicians and patients with simplified billing and reduced EHR burden under Medicare for all. It’s the right prescription for what ails us.

Rani Marx is director, Initiative for Slow Medicine. James G. Kahn is an emeritus professor of health policy, University of California, San Francisco.

Image credit: Shutterstock.com


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