Posts Tagged physicians
Physicians scoff at rules requiring them to use electronic records and now they must pay the penalty.
Melinda Beck reported in the Wall Street Journal 12/18/14 “Medicare to Cut Payments to Some Doctors, Hospitals”. Of the 893,851 physicians in the US, Ms. Beck reports 257,000 will be fined 1% of their Medicare fees for failure to adequately use an electronic medical record.
For example, the technically challenged doctors have failed to use electronic prescriptions, favoring instead marginally-legible hand-written prescriptions. And, they undoubtedly harmed patients by not taking advantage of allergy and interaction checks that are part of electronic prescribing.
AMA president-elect Steven J. Stack is reported as saying he was “appalled” by the government action. Every physician, obviously excluding Mr. Stack, was informed 5 years ago that fines would be imposed in 2014 by Medicare if physicians that bill Medicare fail to use electronic records in a meaningful way.
Why would a rational physician choose not to use an electronic record…?
- Because North Korea might hack the system
- Because the government told them to use an EMR (they give orders, not take them)
- Because they will be retiring soon and won’t need to learn about computers (the real reason)
- Because they will need to pay for a system to help patients
- Because young physicians want the systems, older physicians say no to all this newfangled stuff.
- Because a an electronic record might be used in court against them.
There you have it — a detailed explanation. Appalling, don’t you agree?
Doctors are unhappy because the medical world is not what they expected (or dreamed about).
An essay in the Wall Street Journal today “Why Doctors Are Sick of Their Profession?” describes the feelings of many doctors. What are those feelings? What do they mean?
Most physicians cope very well and are quite successful in society. Clearly, they do not have a psychiatric disorder as a group. Yet, the WSJ article lists certain symptoms. These are feelings of:
frustration, failed aspirations, malaise, worthless sacrifice, loss of control, conspiracy of lawmakers and insurance companies, devalued work, and recurrent intrusions of unpleasant thoughts. Lawyers (the scum of the earth) make more money than they do. And, oppression is keeping them from doing things the “right way”.
If a patient complains of those symptoms the diagnosis would be: depression with underlying obsessive-compulsive and narcissistic traits. For doctors it may just be the world is not what they expected when they started 15 years of training. The job is basically good and it’s too late to start over.
Is money an issue? If a distraught patient says their anxiety has nothing to do with a “recent divorce” … it really has everything to do with the divorce. If a doctor say it “has nothing to do with money” … it’s the money.
As a group doctors have a huge capacity for delayed gratification. They go through difficult years of training by thinking it will get better later — the salary will go up, all the testing will stop, professors will go away, long hours will improve, and no one will question their decisions. Welcome to the real world: stagnant salaries, maintenance of certification tests, professors who set evidence based guidelines, long hours and insurance companies that question decisions.
Medical training is mostly to blame. It’s too long, often unfocused, minimizes teamwork and shuns consistency. The fight for doctors to follow evidence based guidelines is undermined by the constant drum beat of “cook book medicine”. In fact, most medical treatment is by the book — a stunning revelation to most. If physician expectations were better managed during training the dissatisfaction after training would not be an issue.
Many employees find their job the least stressful part of the day. Stressed physicians need to focus on their job of diagnosis and treatment — it is very rewarding. Extraneous worries can drive you crazy.
Accountable care organizations reduce physician stress by focusing physicians on the job of taking care of patients while business professionals manage the business. Perhaps increasing the structure of medical care is the solution for physicians, not the enemy.
Grand poobahs, long robes, ivory palaces, exulted wise men — is it the Arabian Nights? — no, it’s graduate medical education in the US. Finally, a voice of reason — coming from the Institute of Medicine (IOM). The surprising report released 7/29/14 says doctor training is not meeting the needs of the country.
The problems: $18 billion per year going to academic medical centers without adequate accountability. Money lavished on the Northeast fails to trickle down to community training programs elsewhere. Self-serving training of an academic workforce but not main-street primary care.
The US has never had a coherent plan to train doctors — academic medical centers have been making decisions that should have been made by ordinary people, people who don’t like waiting lists. A huge manpower shortfall has been expected for a long time. The IOM expert committee is calling for big changes to the system. The hope of the country, West of Harvard, is that Congress will follow the recommendations — the report is not asking for more money (which would be a stake in the heart) just a rational use of funds to meet obvious needs.
A primary care doctor does not need to go to Harvard to be a very good doctor and the US does not need to support super specialty programs at the expense of towns lacking a doctor. The cost savings by diverting funds to community training programs could be huge, possibly training 2 or 3 physicians instead of one in Boston.
Funding of training needs to be tied to providing service where service is needed. What better way to train doctors for Iowa (or other areas needing doctors) — train young people in the communities where they live.
Patients like a choice of healthcare providers but never are willing to pay much for that opportunity. Recently, insurance companies have taken advantage of shrinking the available panel of physicians to select those that are both less expensive and provide higher quality. The higher quality part is obviously secondary.
Electa Draper of the Denver Post reported 7/27/14 “Coloradans could lose medical choices, but save money”. The essence of the article was a report on the United Healthcare (UHC) plan to “narrow the panel” of available physicians. $100 per month is reported as the possible savings for subscribers to the plan.
UHC is the largest insurance carrier in the US. This national strategy to “narrow the panel” will save someone some money; but, the amount of leverage this gives to quality is nebulous. This huge insurance company could raise US healthcare quality to number 25 from number 26 in the world — sadly they don’t have much ambition for international competition.
The lack of transparency is striking:
- will all the cost savings be passed on to the consumer?
- will CEO Stephen Hemsley’s salary go higher than $106 milllion?
- physicians seem easy to squeeze for money; what about drug companies, device makers and hospitals?
- what quality measures cause physicians to be excluded?
- forcing patients to change doctors as employers change insurance plans is common practice — when will this stop?
- will UHC or any insurance company saying they intend to improve quality also reduce errors? Will they stand shoulder to shoulder with physicians who are named in medical error suits?
- will UHC reduce patient waiting times?
- will UHC drop Medicare patients and stick with younger healthier patients?