A Balancing Act: Treating The Patient vs. The Healthcare System

This post was contributed to the Physicians Foundation Forbes Channel by Walker Ray, MD, President of the Physicians Foundation and Tim Norbeck, CEO of the Physicians Foundation.

The Physicians Foundation recently released its findings from this year’s biennial physician survey.  What surprised us the most, or should we say amazed us, were the 10,170 physicians who took the additional time to send us commentaries that filled more pages than in Gone with the Wind.  That act alone demonstrates how strongly physicians feel about what is happening today to the practice of medicine.  We will close our remarks with a sampling of theirs.

U.S. physicians continue to struggle to maintain morale levels, adapt to changing delivery and payment models, and provide patients with reasonable access to care.  According to the research titled “2016 Survey of America’s Physicians: Practice Patterns and Perspectives,” 80 percent of physicians report being overextended or at capacity, with no time to see additional patients. This remains consistent with the findings reported in the 2014 survey from the Foundation. Not surprisingly, 54 percent of physicians surveyed rate their morale as somewhat or very negative, with 49 percent saying they are either often or always feeling burnt out.

Conducted by Merritt Hawkins, the survey findings are based on a sizable response of over 17,000 physicians and address professional morale, practice patterns, career plans and their perspectives on recently passed government regulations.

In response to these and other challenges, 48 percent of surveyed physicians plan to cut back on hours, retire, take a non-clinical job, switch to “concierge” medicine or take other steps that will further limit patient access – an increase from those who answered similarly in the 2014 survey.  Clearly, many physicians are dissatisfied with the current state of medical practice and are starting to opt out of traditional patient care roles. By retiring, taking non-clinical roles or cutting back in various other ways, physicians are essentially voting with their feet and leaving the clinical workforce. This trend is to the detriment of patient access. It is imperative that all healthcare stakeholders recognize and begin to address these issues more proactively, to support physicians and enhance the medical practice environment.

Other interesting findings include:

  • 3 percent gave the Affordable Care Act (Obamacare) an “A” rating, while 48% gave it a “D” or “F” rating.
  • 6 percent indicated that ICD-10 has improved efficiency in their practice, while 42.5% reported that ICD-10 has detracted from efficiency. On a lighter note, neither of us has yet to find a physician who has used the code for a patient who was sucked into a jet engine.  We will keep asking!
  • 11 percent found that EHRs have improved patient interaction, while 60 percent indicated that they have detracted from patient interaction.
  • Only 8 percent of physicians agreed that the Maintenance of Certification (MOC), required by specialty boards, accurately assesses their clinical abilities.

The answers to two questions in our biennial physician survey since 2008 have remained constant.  First of all, a common theme throughout our surveys since 2008 is that physicians continue to find patient relations to be the most satisfying factor in their medical practice – a full 74 percent.  The “least satisfying” factor is the regulatory and paperwork burdens (58 percent), followed by the erosion of clinical autonomy (32 percent). Medicine is one of the most, if not the most highly regulated profession in the United States, with Medicare compliance rules and regulations alone running into the tens of thousands of pages – and they are constantly increasing.  For example, the new MACRA law revamping Medicare payments to physicians, is 932 pages long.  And physician compliance and paperwork burdens are being exacerbated by emerging reimbursement methods.  New value-based payment models, such as the aforementioned MACRA, require physicians to track countless “quality measures.”  Combined with EHRs, the overall effect serves to divert physician eye contact with patients – something both parties increasingly resent.

A study published in the March 2016 issue of Health Affairs indicates that physicians and their staff spend 785.2 hours annually just tracking and reporting quality measures for Medicare, Medicaid and private insurers, at a cost of $15.5 billion. On top of that, new regulations keep popping up with no end in sight. Physicians spend four years in college, four years in medical school, and three to seven years (and sometimes even more) in residency or fellowship training in order to practice in their chosen specialty. Unfortunately, as all physicians know too well, they often find that their ability to choose what is best for their patients is compromised or obstructed by bureaucratic requirements or third parties who are non-physicians and neither have the training nor the knowledge of the patient that the physician possesses. They also force physicians to be box checkers instead of maintaining important eye contact with their patients.

Speaking of all of these experiences plus new and expensive (to physicians) reporting mechanics and regulations which have the effect of turning patients into data machines, we were taken recently with what is now considered to be the favorite joke in Canada. Substitute health care regulators for NASA, and the joke unfortunately is on us.  It goes as follows:

When NASA first started sending up astronauts, they quickly discovered that ballpoint pens would not work in zero gravity.  To combat the problem, NASA scientists spent a decade and $12 billion to develop a pen that writes in zero gravity, upside down, underwater, on almost any surface including glass and at temperatures ranging from below freezing to 300 degrees Celsius.  The Russians used a pencil.

We close with a short sampling of some of the comments made by more than 10,000 physicians who completed our survey and chose to make their own additional comments.

“This would be the greatest profession in the world only if the government would not be involved.”

“My comments here in general fall on deaf ears.  Healthcare delivery needs to be a free flowing process devoid of external influences that interrupt good care.  The process has become so corrupt that none of us can truly practice medicine.”

“Medicine is not a commodity like soybeans or widgets.  Administration needs to be in the business of making it easier, not harder, for clinicians to treat patients.”

“Go ahead and keep looking over our shoulders, paying us less, and asking us to work more.  Good luck when we all quit.”

“My interaction with the patient in the exam room has been lost and replaced with lots of data entry on my part.  I click away staring at the screen and barely have time to make eye contact with my patient.  This is the greatest loss in my opinion.”

"You have backed us into a corner and you’ll miss us when we are gone.”

“Please discuss quality reforms and requirements and MOC rules with clinicians before implementing them.  They and the EHR (which is largely nonfunctional) have largely ruined the personal life of many physicians and imposed unrealistic, impossible time demands that force MDs to spend more time treating their computers than their patients.”

“Becoming a physician and being a doctor are among the greatest of joys.  Working in medicine is the greatest of disappointments.”

As these eight physicians quoted above (and countless others) have stated, new regulations and more demanding and costly reporting requirements are seriously diminishing a physician’s ability to do their best for their patients. This regulatory morass forced on the medical profession brings to mind Gore Vidal’s observation that “the U.S. was founded by the brightest people in the country – and we haven’t seen them since.”