May 23, 2014
Ask any doctor what inspired him or her to go to medical school, and not one will say it was a vision of spending chunks of their days filling out insurance forms. But that's the reality of the job for many. And as the patient, you might feel their frustration.
In a March column in Forbes, physician Robert Pearl contrasted the mission that drives people to practice medicine and the economic realities that intrude. The column drew more than 400,000 views online and has struck a chord among patients and physicians alike, says Pearl, executive director and CEO of The Permanente Medical Group.
In individual practices, where insurers reimburse doctors on a fee-for-service basis, job satisfaction is "plummeting," he says in an interview with U.S. News. Part of the problem, according to Pearl, is that some doctors are forced to spend nearly half of each day doing clerical work in order to eventually get paid.
Less time for patients
"What's happening in primary care now is we're all being asked as physicians to do more with less or 'work at the top our license,'" says Michael Klinkman, a professor of family medicine at the University of Michigan Medical School. "If I hear that one more time I'm probably going to shout and scream."
With pressures to see more patients each day, doctors have fewer minutes to spend with and listen to each individual, Klinkman says. Cumbersome administrative duties also take their toll, and patients could be affected.
As a patient, you should care about these time restrictions whether you're seeing a doctor for "an acute issue—because you're having a heart attack, and you want to get care right away—or you're getting preventive services because you don't want to have a heart attack," says Reid Blackwelder a family physician in Kingsport, Tennessee, and president of the American Academy of Family Physicians.
"You want to have that time with your physician," he says. "You don't want to lose out for a piece of paper or a phone call for a prior authorization or for hours of documentation, so that a physician pulls away from your care for the burdens of administration."
Doctor or medical coder?
If you're under the impression that front office staff handles all the insurance company red tape, that's not so, Blackwelder says. It's doctors who determine diagnostic codes, based on their encounters with patients.
It would be ideal, he says, if every practice could hire medical coders, who would work in synergy with doctors, using advanced forms of electronic health records to streamline the documentation process.
But, Blackwelder says, while that might be possible for large health providers with the resources to afford professional coders, most solo, small group or rural physician practices just don't have the money to hire more staff.
Do Electronic Health Records Help?
Electronic health records are meant to improve and help coordinate patient care, keeping your important medical data from falling through the cracks.
Ideally, each health professional you see—from an ER doctor to your diabetes specialist—works from the same record and has instant access to complete, up-to-date information. It really does work that way in organized health systems, Pearl says.
In much of medicine, however, electronic health records vary from one medical provider to the next, Blackwelder says, and systems "don't speak to one another." So when patients see a new doctor, they're starting from scratch. And rather than boost efficiency, he says, electronic health records can initially decrease productivity of staff members trying to learn how to use them.
Patient advocate Trisha Torrey says that, at least for now, doctors are overwhelmed. "And when they're stuck in a patient's exam room trying to update the EHR [electronic health record]—they can't find something they need that they're supposed to input—I think their frustration comes across," says Torrey, author of "You Bet Your Life!: The 10 Mistakes Every Patient Makes."
The big picture
Blackwelder says payers—private insurers, Medicare and Medicaid—need to simplify and standardize their reimbursement forms. But documentation woes are just one factor in the dissatisfaction with the current state of medicine, and both doctors call on their professional peers to speak out for change.
Patients "should see this as a transition," Pearl says. "We had a fee-for-service system that worked relatively well for a long time. It's not working now."
There's still plenty of room for optimism, Pearl says. In organizations like his, he says doctors are freed from insurance hassles and have more time to spend with patients—and job satisfaction has never been higher. Pearl, also a professor at the Stanford University School of Medicine, says medical school enrollment in general is at a record high.
The last 20 years have brought vast advances in medical knowledge, and "now we cannot just treat disease in patients such as stroke, but we know how to provide the medications to avoid that stroke," he says. "I find it remarkably fulfilling that we're seeing a decrease of about half in patients having heart attacks. The ability to prevent and cure cancers—that is why I went into medicine in the first place."
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