Has the MD Profession Been Irreparably Harmed?

Physician burnout has been a hot topic lately. You see it anywhere you find a physician. Doctors are tired, worn out, and feel like they’re overworked. Many feel like they’ve become data entry clerks and not doctors. Many doctors feel like all these regulation and reimbursement requirements have gotten between them and the patient. Many are pressured by their employer to hit numbers as opposed to caring for patients.

I could keep going, but you get the point. If you’re a doctor, then you’re living many of these challenges. If you’re not, I’d love to hear from you.

Lately when I’ve heard people talking about the damage the meaningful use, EHR, and now MACRA have caused, I hear those people proclaim that the medical profession has been damaged. Many go on to suggest that irreparable harm has been caused to the medical profession. Is that true?

When I ask these people what the solution is, they say that government should get out of the exam room. While that principle is interesting, it’s not very practical. Most of these doctors that want government out of the exam room still want Medicare to cut them a check for seeing Medicare patients. There’s a big disconnect there and it’s not likely to change.

All of this sidesteps the real issue we have in healthcare. Whenever we talk about lowering the cost of healthcare, that means someone is going to get paid less. Who should that be? Yes, there is the pretty rare scenario that you can lower costs while improving care. I’ve seen examples of this, but it’s an extremely challenging thing to make happen.

Going back to the main question. Is the medical profession irreparably harmed by the implementation of EHR software and other regulations? Certainly, it’s had a significant impact, but I don’t think the harm is impossible to repair. We do need to simplify the hoop jumping that we require from physicians. We do need to improve our EHR software so that it makes the physician workflow more efficient and not less. We do need to find better incentives that provide for health data sharing and deeper engagement with patients. All of these things will help repair the medical profession. Doing so will create a whole generation of doctors who can’t imagine what it was like to practice medicine without an EHR.

About the author

John Lynn

John Lynn

John Lynn is the Founder of the HealthcareScene.com, a network of leading Healthcare IT resources. The flagship blog, Healthcare IT Today, contains over 13,000 articles with over half of the articles written by John. These EMR and Healthcare IT related articles have been viewed over 20 million times.

John manages Healthcare IT Central, the leading career Health IT job board. He also organizes the first of its kind conference and community focused on healthcare marketing, Healthcare and IT Marketing Conference, and a healthcare IT conference, EXPO.health, focused on practical healthcare IT innovation. John is an advisor to multiple healthcare IT companies. John is highly involved in social media, and in addition to his blogs can be found on Twitter: @techguy.

3 Comments

  • Without a doubt the answer is YES.

    Ask ANY front line MD.

    To conclude that since Medicare cuts us a check, that they deserve to be in the exam room is EXACTLY the wrong answer. Have they not proven that already?

    This is a very dark period for MDs. I would suggest that policy makers of the next admin, listen better. Just because Andy S tweets out he is listening, does not mean he is. He can tweet hundreds of ACA support tweets and did near zero about the perils of over regulating MDs and needing to lessen burden on us. He changed names ACI from MU and QPP from PQRS and ADDED CPIA. Like we needed that. How is that listening? They ADDED attestation about MDs actually data blocking? We are in the jungle with no map compass or machete. Its no information highway here and to suggest that MDs are controlling information is a joke. We are getting nicked to death with 1000 small cuts of data entry and self reporting “value” measures, like that will make any difference. Oh yeah, there has been NO improvements in 10 years of PQRS, so lets continue that. Same with MU 8 years later, still failing to do ANYTHING meaningful. We need to kill CertEHR and allow innovation back in.

    So lets get real here, is the problem MDs? No way. John, how much do you think I get paid to replace your failing hip? So you can walk again, hopefully for at least the next 20-30 years without any issues? Free care for 90 days after surgery? Guess? $5000? Nope $1300. Yep thats it. 2 packs of EpiPens. CMS wants to squeeze more out of my care? Puhlease.

    How about big pharma? they can indiscriminately raise prices double digit percentages, every few months, and nothing is done. Oh yeah, EpiPen gets called out on it, they take a $1 med and say we going to do a generic for $300 instead of $600. Wow, so nice. How about taking the hatchet there? They give MDs a 0.5% increase for a couple of years then zero for 5. Yep ZERO percent increase. Like everyone wants to get a zero raise for 5 years and that the cost of business is going up by zero. Ridiculous.

    There are literally dozens of people making money on MY work. From admins, registries, MOC, nurses, OR staff, etc etc. And you want to pound percentages out of me for not reporting my value? Driving MDs out of practice is NOT the right idea. And when >50% are burned out, that is a crisis. And its criminal that CMS is NOT listening. We need a strong leader that does NOT believe in hyper-regulatory action on MDs to gain cost containment.

    John, ask around, ask your front line MDs friends. Its a nightmare out here. And its getting worse daily. Do NOT expect care, costs or patient satisfaction to improve when you beat MDs to an inch of their life every day. And every day, I get news of someone quitting, retiring, or killing themselves. You have lost our hearts and minds.

  • If the answer is yes, then I guess you’re saying it can’t be repaired? You might argue that given the current trajectory, it’s unlikely to change, but that’s different than it can’t be repaired.

    Just playing devil’s advocate here, but I’ve heard people make the case that doctors were living so high on the hog for years that now it’s been hard to leave that golden age of being a doctor. I’m talking about payment here and not regulation requirements. I think that’s an interesting discussion. Have we gone too far in some cases? Probably so (looking at you general medicine).

    I don’t think I’ve lost the hearts and minds of doctors. I’m the one calling for help for doctors and an understanding of the challenges they face along with changes to improve their lives.

  • I am not a physician, but I personally do not believe medicine can be repaired. I believe the only course for physicians who really care about their patients is Direct Primary Care. At least for the general practitioner.

    What I do bring to this issue is an understanding of what expertise is. It is not checklist. It is not AI. Real expertise is based upon experience and the human ability to remember some symptom from 30 years ago, probably involving graphic memory.

    The Dreyfus brothers have studied this kind of thinking for years. Attending to clicking boxes on a screen, asking useless questions to qualify the bean counting, inability to listen to patient story—all destroys the mind’s ability to exercise true expertise. I’ve written about this on my blog, both at “Novice vs Expert” and “Open Letter to Andy Slavitt.

    Medicine cannot be repaired until the distractions from physician expertise are removed. Beancounting, checklists, EMRs can be substituted for medicine, but that is bandaid medicine, not expert medicine.

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