Is the healthcare industry tone deaf to physicians’ complaints?

The Physicians Foundation 2018 Physician Survey, published on Sept. 18, 2018, features opinions of our nation’s physicians—opinions that are sobering and should sound a loud wake-up call. 

When distilled down to the very essence of the report, the “fixes” for our broken healthcare system are not only not working, they are causing even more problems. 

Electronic health records (EHR), payment for quality, hospital and physician alignment, interoperability and other initiatives do not have the promised results.  The Feb. 14, 2019, Modern Healthcare A.M. article, “Quality of care isn’t better at physician-employed hospitals, study shows,” is yet another independent study highlighting the chasm between what was supposed to happen and what is happening.  I think we may be on a runaway train to nowhere at tremendous cost and burden with little or no return on investment.  Consider that most physicians have spent longer becoming a physician than the rest of us spent in kindergarten through high school graduation.  Thoughtfully listening to what our physicians tell us could pave the way for the best patient outcomes.  What are those key lessons?

  • 61 percent feel negative about the future of medicine
  • 55 percent of our physicians describe morale as negative
  • 78 percent experience feelings of burnout
  • 80 percent say there are at capacity or overextended
  • 46 percent say the relationship with hospitals is negative
  • 47 percent say payment is tied to quality but only 18percent believe it improves patient care or decreases cost. For hospital-employed physicians, that number is worse. 
  • 58 percent say it does not improve quality or decrease cost. Only 13percent believe those goals are met.

Greater than 70 percent of adult patients have at least one unhealthy habit such as, smoking, obesity, or excessive alcohol use.  31 percent of patients do not follow the treatment plans.

Although it varies by state, the average waiting time for a new patient appointment in family medicine is 72-153 days. 

More than 30 percent of primary care providers do not accept Medicaid and 22percent don’t accept or limit Medicare patients

A full 23 percent of physician time is spent on non-clinical activities or responsibilities such as insurance or other administrative requirements

When our physicians were asked what the biggest impediments are to practicing medicine, it is blatantly obvious; EHR, regulations and insurance, and loss of clinical autonomy.  In fact, EHR dissatisfaction continues to grow, increasing 12 percent since 2016.  Specific to EHR, about 28 percent say it improved quality, about 25 percent believe it improved efficiency and only 8 percent believe it improved patient interaction, a large decrease from 33 percent in 2016.  In fact, 66 percent now say it is a detraction from patient interaction.  That mirrors what patients think about providers more involved in clicking boxes than eye contact and listening.  When combined with the growing risks associated with EHR inaccuracies such as coding and billing, enforcement interest, medical malpractice risk, etc., this is a serious red flag for the healthcare industry.

As the physician shortage continues to grow due to; retirements, leaving clinical medicine for other careers, declining medical school enrollments and lost patient time to non-clinical requirements, the negative impact on patients will also grow.  The 23percent of time spent in non-clinical activities alone is equivalent to an estimated loss of 19,200 full-time equivalent hours.

The most shocking and sobering finding from this survey is that depression is common, and suicide is stated to be the highest of any profession.  Possible causes are the complete disconnect between physicians and non-clinical third parties, such as the Centers for Medicare & Medicaid Services (CMS), insurance, and regulations determining practice requirements.  Our physicians’ ability to do what they trained for and what attracted them to the practice of medicine has been circumscribed by external forces.  In essence, physicians cannot be physicians and do what is best for their patients. 

Our loud wake-up call is we are killing our physicians, figuratively and literally.


Program Note:

Listen to nationally renowned psychiatrist H. Steven Moffic, MD report on physician burnout live today on Talk Ten Tuesday, 10-10:30 a.m. EST.


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