Best or Worst of Times for Medical Practice? 

By Jill Zorn 

“Is it the best of times or the worst of times for the practice of medicine?”

This is examined in a series of columns in Forbes Magazine by Robert Pearl. And the answer appears to be “it depends.”

The Worst of Times?

There is a lot of evidence out there that physicians, especially those who are veterans in the field, are unhappy with the tumultuous changes underway in medicine.  A recent survey of primary care physicians conducted by the Commonwealth Fund found:

47% are considering early retirement due to “recent trends in health care”  

Another study conducted in 2014 by the Physicians Foundation found:

50% would NOT recommend medicine as a career to their children 

Many physicians are clearly suffering from change fatigue and find they are losing their cherished professional autonomy.  As Pearl writes:

Physicians report….feeling relentless pressure from multiple quarters, including insurance companies, regulators and the legal system. Increasingly, the business of medicine is interfering with the practice of medicine.

The Best of Times?

Yet, medicine is still seen as an incredibly rewarding and respected career.  Applications to medical school are up. The Physicians Foundation survey shows, that while morale is low, it may be improving:

Capture

The increased focus on measuring quality and improving health, while it puts more demands on physicians and their practices, also offers them the opportunity to practice more effectively.

Focus on the Patient

The number one reason that people go into medicine is to help patients.  While on the surface, changes in payment and delivery models are intended to benefit patients, the way they are implemented often has the exact opposite effect.

For example, the use of an electronic health record (EHR) should mean that care is better because providers have patient information readily available.  And the collection and storage of data is crucial to the measurement and improvement of care and ultimately of patient health.

In practice, however, as many of us have experienced, the EHR can get in the way of the therapeutic relationship between patients and providers.  It can feel like the physician is interacting more with the computer than with us.  As Pearl explains:

Entering and retrieving information….and the high number of clicks required, even for relatively simple problems makes many physicians feel like data-entry clerks… Most problematic, the EHR often proves to be a distraction for physician and patient alike during the clinical encounter itself. The doctor, instead of making and maintaining eye contact while taking a history, faces the computer, sacrificing the personal connection between doctor and patient so valued by both. The presence of the computer and the time data entry decreases communication, both verbal and non-verbal.

Despite these problems, the Commonwealth Fund survey found that 50% of primary care physicians felt that health information technology was having an overall positive impact on their ability to provide quality care.  But they took a less sanguine view of the impact of other major changes on their ability to provide quality care:

33% felt that Patient Centered Medical Homes were having a positive impact 

14% felt that Accountable Care Organizations (ACOs) were having a positive impact 

Interestingly, these rates are somewhat higher for physicians who actually practice in those environments (43% for those working in medical homes and 30% for those participating in ACOs).  Satisfaction was highest among Physician Assistants and Nurse Practitioners working in these environments.

Overcoming Change Fatigue

Physicians and other health providers experiencing change fatigue should do all that they can to make sure that their workplaces support innovation that benefits patients.  Here are two organizations where physicians committed to positive change can turn. Both of these organizations work closely with health care advocates, too.

National Physicians Alliance (NPA) offers “a professional home to physicians across medical specialties who share a commitment to professional integrity and health justice.”  Their 10th annual conference, “Truth to Power, Alliance for the Public Good,” will be held in Washington, D.C. on October 17 and 18.

Lown Institute seeks to “catalyze a grassroots movement for transforming healthcare systems and improving the health of communities.”  Lown “ is sponsoring “RightCare Action Week” from October 18-24.

NPA and the Lown Institute are fighting for health systems change that leads to the best of times for both physicians and patients.

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