What if your Practice has an Older Physician who does not want EMR?

A fair amount has been written / blogged on EMR for the individual physician facing retirement.  But I have come across a more complicated variation of the question.  What if a multi-physician group has one physician approaching retirement who is the “lone hold-out,” opposing EMR while the rest of the docs in the group are ready to take the plunge?

The older physician has a point.  The EMR implementation will likely require a large capital expenditure, reducing the value of the practice in the short term and adversely affecting the value of his retirement buy out.  The doc nearing retirement age may have difficulty with the IT skills necessary to master EMR and may not be practicing long enough into the future to see the long term return on the investment required to get those IT skills.

The older physician in this scenario may ask to opt out of the expenses of the EMR project when his income is calculated and to have his retirement buy out calculated without the EMR liability figured in.

That might sound like a good way to resolve a difficult dilemma…unless you understand the physician personality.  The problem is that we docs love our work too much.  That is partly why Medicare, Medicaid and private managed care providers have been able to sharply reduce our payments over the past 15-20 years, and we just keep showing up for work.  As a rule we don’t face retirement well.  Many of us never retire; we just die with our boots (or scrubs) on.

So the older doc who claims to be ready to retire may not retire as soon as he thinks.  So do you let him opt out of EMR or not?

I would be happy to let him opt out of EMR…provided he commits in writing to a retirement date and allows the practice to begin making plans to recruit a replacement physician.  The date would be fairly soon, no more than 18 months in the future.  If he fails to retire by that date he would begin incurring costs related to EMR, both in take-home pay and retirement buy out.

This approach avoids the nearly impossible task of trying to calculate the return on investment “break-even point” for an EMR purchase, as many authors try to do.

About the author

Dr. Michael Koriwchak

Dr. Michael Koriwchak

Dr. Michael J. Koriwchak received his medical degree from Duke University School of Medicine in 1988. He completed both his Internship in General Surgery and Residency in Otolaryngology-Head and Neck Surgery at Vanderbilt University Medical Center. Dr. Koriwchak continued at Vanderbilt for a fellowship in Laryngology and Care of the Professional Voice. He is board certified by the American Board of Otolaryngology-Head and Neck Surgery.
After training Dr. Koriwchak moved to Atlanta in 1995 to become one of the original physicians in Ear, Nose and Throat of Georgia. He has built a thriving practice in Laryngology, Care of the Professional Voice, Thyroid/Parathyroid Surgery, Endoscopic Sinus Surgery and General Otolaryngology. A singer himself, many of his patients are people who depend on their voice for their careers, including some well-known entertainers. Dr. Koriwchak has also performed thousands of thyroid, parathyroid and head and neck cancer operations.
Dr. Koriwchak has been working with information technology since 1977. While an undergraduate at Bucknell University he taught a computer-programming course. In medical school he wrote his own software for his laboratory research. In the 1990’s he adapted generic forms software to create one the first electronic prescription applications. Soon afterward he wrote his own chart note templates using visual BASIC script. In 2003 he became the physician champion for ENT of Georgia’s EMR implementation project. This included not only design and implementation strategy but also writing code. In 2008 the EMR implementation earned the e-Technology award from the Medical Association of Georgia.
With 7 years EMR experience, 18 years in private medical practice and over 35 years of IT experience, Dr. Koriwchak seeks opportunities to merge the information technology and medical communities, bringing information technology to health care.


  • Thank you for your post. Older and retiring physicians is an issue that EMR implementers face on a regular basis. The driver to get them on board is to communicate to them that their practice is more valuable if it is in an electronic format than paper. Young physicians who want to take over an existing practice are more likely technically savvy already and would find more value and be more inclined to have a practice already using an EMR. If implementation cost is an issue with an older physician, there are free EMR options out there that will get them past this hurdle. Mitochon Systems for example, provides a free certified integrated HIE/EMR/PHR system that is a no risk option for them. They update their practice to digital, and qualify for their ARRA monies, and provide a more compelling reason for a young physician to step in when they are ready to retire. For more information on the Mitochon System’s offering please see http://mitochonsystems.com.

  • Great post Michael. No doubt there are a lot of interesting dynamics like this in a group practice. I’m glad you’re bringing them to light.

    What I’ve found interesting in my experience is many of the really close to retirement age doctors that I know are actually quite happy to adapt to an EMR. They have some learning curve, but they aren’t generally the problems (although there are exceptions).

    I’m not sure exactly why, but I think it might have to do with demeanor and their easy going personality and love of what they’re doing. If they didn’t have these qualities they would have retired from the medical profession already.

    The hardest ones are the middle to upper age doctors that have 5-10 years before retirement. When they don’t want an EMR it’s an ugly situation.

  • I’m not sure what the dynamics are or other factors so I’m unlcear why a single hold out presents a problem with the group implementing an EHR or not.

    One factor that sometimes can cause older physicians from being slow to engage and implement an EMR is if that older physician owns the practice in question … while the younger ‘tech savy’ physicians are either junior partners or employees. Typical of any small business owner… the older physician may be looking for the right ROI that would justify ‘Dr. Welby’ getting a loan to pay for the EMR implementation and offset the revenue dip during the period the practice is getting up to speed.

    Some of that is lost on younger docs.

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