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Electronic Medical Records, Administrative Burdens Are Causing Physicians’ Fatigue

November 26, 2019
By Michael Ciampi, M.D.

I must admit I have mixed emotions about the National Academy of Sciences, Engineering, and Medicine report.

I believe the researchers have correctly identified many of the factors that contribute to “burnout,” namely that this is problem of the health care system, not individuals.

I also agree a large part of the problem is the way the system has changed in recent years, with the essentially compulsory implementation of electronic medical records (EMRs) hastily designed to comply with government mandates, namely the HITECH Act of 2009, rather than to assist clinicians in providing and documenting high-quality care.

EMRs for Billing, Not Quality

EMRs, which are essentially medical billing software systems with some medical documentation and ordering capability tacked on, have placed huge and unnecessary administrative burdens on busy physicians. They are designed to capture and document enough information to justify charging for more expensive visits rather than to help health care professionals share vital patient information with each other.

The fact that a physician spends 50 percent or more of the workday looking at a computer screen rather instead of at patients has led to great job dissatisfaction for clinicians, along with patient dissatisfaction. The already unhappy clinicians are the ones who feel the wrath of the equally unsatisfied patients several times a day.

Devaluation of the Physician

The report misses one of the main causes of physician disenfranchisement, which is the loss of control and devaluation.

 In most other industries, personnel with the levels of education and experience of physicians would be major decision makers and senior executives. In the past, physicians had these roles. Now, however, with the exponential increase in hospital administrators, physicians have a much smaller voice not only in large, strategic decisions within their organization but also in how they do routine work.

Physicians’ clinical judgement is often overruled by hospital committee-established boilerplate protocols. They must appeal denials of coverage by insurance carriers, and they have coding specialists looking over their shoulders making suggestions on how they should document care so a hospital can maximize revenue.

Physicians now feel more like cogs in a machine and glorified data entry personnel than valued clinicians leading a health care team and advocating for their patients. This trend will probably get worse as the percentage of physicians who are employees of hospital systems continues to climb.

Foxes Guarding the Henhouse

The six goals outlined by the report all sound good at a high level but seem to be superficial platitudes instead of real solutions to underlying root causes. This comes as no surprise because the people and organizations involved in crafting the report are some of the very same people who helped create the current dysfunctional system in the first place.

In particular, Christine Cassel, who is mentioned prominently in the report, is loathed by countless board-certified internal medicine physicians for the role she had in increasing their financial and administrative burdens by raising fees and educational requirements for Maintenance of Certification while she was the head of the American Board of Internal Medicine.

People like her have no credibility in the eyes of most practicing physicians. Reports such as this seem to be little more than window dressing that will garner some attention at first but will not be followed up by substantive action to identify and address root causes.

 

Michael Ciampi, M.D., (think@heartland.org) is a physician in Portland, Maine and policy advisor to The Heartland Institute.