unhappydoctor

I ran into Dr. B. last week, a physician I really like and respect. She was seeing a patient in the hospital and I was visiting a friend who’d just had surgery. We stopped to chat. After exchanging pleasantries, Dr. B. made a comment about the sad state of healthcare. Because she knew about my books and articles on healthcare, inevitably we touch on it when we see each other.

Lingering in the hallway, the familiar sounds of the hospital around us, she said, “Many physicians are deeply frustrated. I know several who have jumped ship.”

“Me too,” I said. I thought about the number of physicians I’d interviewed for my latest book, The Take-Charge Patient, who were frustrated and disillusioned with the direction healthcare was taking. About half of them just needed an ear, wanted to vent about how disappointed they were in the profession they had chosen. Many questioned the logic of staying in medicine now that their relationships with patients had dwindled and how health insurance had taken over as gatekeepers and decision makers for patient care. This was before electronic medical records had been fully implemented.

Dr. B. said, “Oncologists are selling their practices to hospitals.”

“GYNs and other specialists too,” I said.

Dr. B. sighed. “Where do you think healthcare is going?”

I wasn’t sure how to respond in a sensitive way given that she is a doctor in the thick of the healthcare mess. I decided that honesty was the way to go, especially considering that as a patient, I am in the thick of it too. “Technology with a big emphasis on efficiency.”

Technology already plays a major part in healthcare and certainly for physicians. According to a new study published in Mayo Clinic Proceedings electronic health records (EHR) and the digital entry required to maintain them, is in part, driving doctor burn out. Intended to prevent medical errors and increase efficiency, digital healthcare requires much more screen time for clinicians. Digitation of healthcare takes away from interaction with patients. Interaction with patients is a large source of satisfaction for physicians.

Dr. B. nodded and said, “I think we’re headed toward a bigger divide between the ultra rich and the not-so-rich.”

I said, “You mean longer wait times for care and less accessibility unless you have the money to pay for it?”

“Yes.”

I understood what she meant–that the rich could afford to pay cash to physicians who don’t take insurance or could see concierge physicians, both allowing for more immediate access and more face time with doctors.  That often translates into increased quality of care and more emphasis on the all-important doctor-patient relationship. When doctors and patients bond and connect, outcomes improve.

Her cell phone chimed and she reached for it. Her eyes on the screen, she mouthed the words, “I have to go. Good to see you.”

We both dashed off to our respective destinations in the hospital. Our brief conversation kicked up my own disappointment with the direction healthcare seems to be taking and I made a mental note to do some research on it later in the day.

What I found wasn’t news to me but I hadn’t been aware of the current level of frustration with medicine. I read the HealthLeaders Media article, 1 in 2 Physicians Demoralized, Dissatisfied. It said, “Half of physicians are dissatisfied with the current medical practice environment and they are opting out of traditional patient care roles.” The article cited a new nationwide survey commissioned by the Physicians Foundation.

I was reminded that it isn’t just patients who suffer the maladies of our current healthcare system but physicians too. And a lot of them. Doctors who I interviewed for both of my books opened my eyes to widespread frustration and disillusionment.

Nurses are frustrated too. Their quest for safe staffing to salvage patient safety and quality of care seems like it would have been implemented years ago. If a nurse is caring for too many ill patients at once, safety and quality of care are compromised.

If half of physicians surveyed by the Physicians Foundation are deeply frustrated and burned out by healthcare, what can be done to bring back fulfillment and satisfaction to their work?

That burnout, experienced by nurses too, affects everyone involved in patient care, including patients. According to the AHRQ Patient Safety Network, “Burned out clinicians may develop a sense of cynical detachment from work and view people—especially patients—as objects. Fatigue, exhaustion, and detachment coalesce such that clinicians no longer feel effective at work because they have lost a sense of their ability to contribute meaningfully.”

Physician burnout has been associated with decreased patient safety, increased diagnostic errors and less patient engagement. See Health Affairs article, Make the Clinician Burnout Epidemic a National Priority

With the pressures and requirements driven by the Affordable Care Act (ACA), its no wonder so many clinicians are finding other ways to survive in healthcare, either by becoming concierge physicians, offering more income-producing services, selling their practices to hospitals, and more. Some are getting out completely.

Most physicians I interviewed for The Take-Charge Patient did not think highly of the ACA. Many predicted that it would crush the practice of medicine as we know it.

With declining reimbursements and more time spent on data entry to fulfill electronic health records (EHR) requirements mandated by the ACA, physicians see even more patients in a day just to survive. The Forbes article, The Story Behind Epidemic Doctor Burnout and Suicide Statistics reports, “On a typical day, Dr. X would arrive at the clinic with a full schedule consisting of 20 to 25 patients. Dr. X said, “If you do the math, that limits my time with each patient to seven to ten minutes.” He goes on to say that in those seven to ten minutes he had to address the acute problems that brought patients into his office plus those with chronic conditions. Dr. X added, “Most of those minutes were spent interacting with the computer screen.”

Dr. X also explained that “Meaningful Use” requirements forces doctors to spend more time filling out forms and dealing with coding requirements, which leads primary care physicians to refer patients more often to specialists because they just don’t have the time to address the problems themselves.

To fuel the fire, health insurance has lassoed healthcare. Some physicians opt to forgo accepting health insurance altogether or to transform their practices into concierge which comes with a price for patients. Narrowed networks on health insurance plans deny patient access to certain clinicians, hospitals and other healthcare facilities, forcing patients to find other doctors and care from other facilities.

With the dramatic increase of high deductible health care plans in both group and individual markets, results are mixed, at least for now, on whether patients are actually avoiding necessary care or whether they are becoming cost-conscious users of healthcare services.

Personally, I know of many patients who do not seek care from their doctors because high deductible plans have converted them into cash-pay patients and they simply cannot afford to pay the high deductible before their plan kicks in. See my article in KevinMD on Cash Pay Patients and High Deductible Plans. This affects physicians and other clinicians too. If a patient doesn’t see his/her doctor or nurse for, let’s say, diabetes management because of the expense, then how can that clinician take care of the patient properly? How does that patient effectively manage the chronic condition on his or her own? The rationale for high deductible plans is that patients will use fewer healthcare services and save money for everyone.

Hmn. I’m not sure I agree.

For years, health insurance has overruled what physicians knew to be best treatments and tests for their patients. For good reason in some instances to prevent over testing and fraud. But as I see it health insurance has zapped some of physicians’ sense of autonomy and effectiveness. This too contributes to physician burnout. It certainly frustrates patients.

Who is getting caught in the drain? Seems like doctors, nurses and patients.

The ACA does have benefits. Preventing health insurance plans from denying care to those with pre-existing conditions is an obvious vital change. Offering access to care to those who were previously denied it, is also an essential benefit. But at what cost? Unfortunately, the ACA has robbed Peter to pay Paul.

What can be done?

I don’t claim to know the answers. I do very much welcome your comments.