How are the nation’s biggest and best health-care organizations managing all the changes in health care? I found out at the Group Practice Improvement Network in New Orleans this month.
One speaker said 58 percent of primary care physicians are “burned out.” Less than 40 percent say they are satisfied with their work-life balance. I can attest to this – I am tired. The changes in the practice of medicine over my short career have been overwhelming. I came out of residency bright-eyed and eager to make a difference. Those first five years were glorious: Learning how the body is fearfully and wonderfully made, building lasting relationships with patients, promoting health and healing. Then, life as a physician started to change.
First, technology disrupted the physician-patient encounter via the EHR (Electronic Health Record). The old adage that you can’t read a doctor’s writing was to be remedied with the EHR. It was supposed to minimize errors, create a unified repository for patient information and allow better communication among all members of the health care team. Instead, I now joke to my patients that I’ve been to medical school to be a data entry clerk. I spend more of my time looking at the computer screen instead of the patient. I must order everything my patients need through the CPOE (computer provider order entry). On average, that adds about 7 minutes for every patient. If I see 20 patients a day, that’s 140 minutes (or 2.5 hours). I don’t have an extra 2.5 hours to spare.
Conversation after conversation at this conference was around making technology work for us. It’s not working yet.
Through our technology, we have created the ability for patients to “message” us through a secure portal. This is great, but when am I going to answer such messages? Unfortunately, it takes the time I should be watching my four kids at their ballgames or serving at my church.
Doctors are now judged on how many quality goals their patients achieve. I’m graded on what my patients choose to do. I was trained to be a consultant, a coach and an advocate for my patients. But ultimately, my patients have a choice. They can choose to adhere to my advice or not. If a patient chooses to exert his own will and do something else, I am labeled a bad doctor. That means the payers say I am “tier 2,” that I have not met all the metrics. So, my patients are steered away from me. They are told by their payer they can still see me, but their costs will be higher. So I lose my patients.
The pressure to get it right is not only coming at us externally, but also internally, from our own licensing bodies. As an internist, every 10 years I have to go through recertification. I have to take an exam woefully inadequate at testing what I do in my job. The session I took the exam, the pass rate was just 63 percent. I passed. But it was one of the most demoralizing experiences of my life. I have to take it again in seven years and I’m already dreading it.
A speaker at the New Orleans conference said 1 in 3 doctors is over 50, and one in 4 is over 60. And, according to a 2013 Deloitte survey of more than 20,000 doctors, 62 percent were going to retire early due to the changes in health care.
I want to restore the joy of practicing medicine. It is estimated that by 2025, the demand for physicians in America will exceed supply by up to 90,000.
I’m going to do everything I can to empower my partners to keep caring for the patients they know and love. Your doctor does not want to leave you. He or she is just tired.
Teague is the Director of Internal Medicine for Carolinas HealthCare System Medical Group.