![]() The options for leaving include going part-time (because everyone knows the secret that part-time is actually full-time), joining concierge practices that cap at 200 patients compared to 2,000, or quitting medicine entirely. But doctors must pick their poison: they speed up and miss important details, spend their nights and weekends carrying over work, or leave. The result is a perfect storm that drives good doctors out of traditional medical practices while patients lose outlets to communicate with them. ![]() Read More: What to Do If Your Doctor Isn't Listening to You When attempts to secure timely appointments fail, patients turn to messaging, moving the deluge for doctors to another uncompensated channel that many practices are now trying to disincentivize by tacking on a charge. Meanwhile, each patient competes against thousands for coveted appointments. All the extra works spills into doctors’ off hours. With the financial incentives stacked to book as many patients as possible in face-to-face visits, appointments get compressed to fifteen minutes and a typical primary care doctor’s panel swells to over 2,000 patients. Moreover, fee-for-service generally reimburses more for visits with new patients than appointments with patients following up. Nothing else directly counts as paid work: not communicating with patients in between visits, not following up on test results, not digging through medical records, and not discussing cases with other doctors. In primary care, that service has been commodified into the office visit. Here, health organizations or doctors get paid based on discrete services they provide. still operate according to fee-for-service. Despite pushes in recent years for payment models that focus on value, the vast majority of health care organizations in the U.S. In comes the final mismatch: between what is paid for and what medical care requires. Managing a patient’s case in this fragmented system requires better tech and team support. But while team support and delegation has caught on in the hospital setting, it lags in primary care where the doctor often plays all roles at once. These clinics also hire nurses who can manage tasks such as refilling prescriptions, triaging patient calls, and answering messages. The best run clinics understand this and train medical assistants to do much more than stock clean gowns and take vital signs. How many of those steps needed to be done by me? In my estimate, only about half of my daily work actually needs to be done by an MD. Recently I prescribed a medication that took 22 clicks, waiting on hold with an insurance company, tracking down a denial letter, writing an appeal, documenting all these phone calls, and keeping my patient apprised through messaging. Support staff becomes crucial, yet patching logistical holes often falls to doctors. It was supposed to be the other way around. Our current solution to these technologic glitches is leaning on people to serve the needs of the electronic charts. In an era where multibillion dollar software promises to ease data-sharing, the process for providers to input and find health data remains manual, labor intensive, and error prone. The practical result is that doctors spend hours digging through disorganized charts, sleuthing for critical patient data that gets buried under an avalanche of noise. Nearly 60 percent of doctors’ notes are identical, and therefore redundant, to the previous ones. The number of clicks in one ten-hour shift in the emergency room approaches four thousand. Ordering something as simple as Tylenol requires doctors to click between fourteen and sixty-two times, with the confusion causing errors in up to 30 percent of cases. Doctors today spend two hours doing computer tasks for every one hour facing patients. However, the very technology that was supposed to reduce doctors’ work has drastically increased it. Paper records were converted to electronic charts over a decade ago, with the incredible potential to connect enormous amounts of patient data seamlessly. Ironically, a big culprit is electronic medical records. But the ways doctors’ workloads are exploding are largely clerical and bureaucratic. As a practicing internal medicine physician and oncologist, I believe we reached this unsustainable state due to fundamentally misaligned division of labor – between human and machine, between doctors and support staff, and between what is paid for and what good medical care requires.Īs a doctor, I am no stranger to hard work. ![]() This is the paradox that defines modern American medicine: Doctors are working harder and longer, all while patients can access us less.
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