Doctors Were Not Meant to Treat Their Computers

COMMENTARY Health Care Reform

Doctors Were Not Meant to Treat Their Computers

Sep 28, 2018 3 min read
Kevin Pham, MD

Former Visiting Policy Analyst

Dr. Pham was a Visiting Policy Analyst at The Heritage Foundation.
A severe shortage of physicians is in the making. jacoblund/Getty Images

America faces a physician crunch. The American Academy of Medical Colleges projects a physician shortage of between 42,600 and 121,300 doctors by the year 2030.

Certainly, there’s no shortage of demand for medical care. More of us are living longer, with more complicated health problems. But practicing physicians are accelerating their retirement plans, even as fewer and fewer doctors enter the physician workforce.

A slow-moving shift in the focus of U.S. health care has set this physician flight in motion. The system that once centered on the doctor-patient relationship today revolves around the provider-payer relationship.

And doctors hate that.

Retirement decisions are personal though, many physicians choose to keep practicing for as long as they can. However, recent polling from the Physicians Foundation found that half of physician respondents over the age of 45 intended to accelerate their retirement plans due to changes in healthcare and the practice of medicine.

By 2030, almost 30 percent of the physician workforce will be of retirement age. If they follow through with their stated intentions, we may lose up to a third of our doctors.

Many other doctors are choosing to work fewer hours. This is especially true for the younger, newly trained physicians who will be replacing retirees. The American Academy of Medical Colleges estimates that such decreases in working hours will reduce medical services by the equivalent of 32,500 full-time physicians.

Our future health may, quite literally, hinge on our ability to reverse the forces driving doctors out of medicine.

A good place to start is the Center for Medicare and Medicaid Services (CMS), which sets the tone for much of medical practice in the U.S. Indeed, CMS’ Evaluation and Management (E/M) codes dictated the precise manner in which a physician must document a clinical encounter.

Doctors must follow these guidelines exactly to receive compensation from Medicare. Most insurance companies also require E/M documentation for compensation. Sadly, the guidelines are designed for billing coders and auditors more so than for healthcare providers communicating within the patient-care team.

This was more or less tolerated for years, since the clinically relevant information was present and the extra details were relatively simple to check off on paper forms. However, the move to electronic health records — also mandated by CMS — dramatically changed the process. As a result, according to a study in Annals of Internal Medicine, doctors often spend twice as much time on their computers as they do with their patients in the ambulatory setting. The Physicians Foundation reports that, across the whole medical field, physicians’ now spend a fifth of their time on paperwork. That’s the equivalent of assigning 168,000 physicians to full-time administrative duties.

Relieve doctors of some of that computer deskwork, and they would be free to do more of what they are trained to do: restore sick people to health to the best of their abilities.

Suffocating administrative requirements do more than just eat up physicians’ time. They take a toll on the physicians themselves.

Doctors frequently cite administrative burdens as the biggest contributor to job dissatisfaction. A Medscape report identified it as the largest contributor to physician burnout, a phenomenon felt “often or always” by nearly 50 percent of physicians. As a result, today over 50 percent of physicians are pessimistic about the current state of medicine, and over 70 percent are pessimistic about its future. Small wonder so many physicians are considering early retirement.

And what are these veteran healthcare providers telling the next generation? Nearly half are advising them to avoid entering the medical field.

Lawmakers love to debate sweeping proposals to overhaul the health system, but they must not forget that there is no healthcare without healthcare providers.

A severe shortage of physicians is in the making. Leaders need to start focusing on that now, concentrating on how to improve physician recruitment, training, and retention.

Yes, you can get more TV time by talking up grand schemes like single-payer. But it’s the decidedly non-glamourous work — like revising the E/M documentation guidelines to reflect clinical needs — that will improve health care and keep doctors in the system.

There’s more to be done, of course. Reporting requirements must be simplified. Vendors of electronic health records must given space to innovate. The small, subtle work of regulatory reform and targeted legislated actions can have tremendous impact.

To save American healthcare, we must first work to unburden those who will provide the healthcare. Before we do anything rash, let’s do something small and rational.

This piece originally appeared in The Roanoke Times

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