Thursday, January 17, 2019

Physician Burnout, Thanks to Obamacare

Debates over health care most often assume that if only we spent more money all would be well. The trendy solution is Medicare for all, a version of the national health services that many European countries offer. As for whether we can afford it, people seem to believe that we can just borrow the money. As for whether it will produce high quality health care, the likelihood is that it will not.

Obamacare was supposed to be a step toward better medical care for all. Among its great innovations was electronic medical records. It made a lot of sense. The behavioral economists love it.  It seemed very high tech. In practice, it was not so good.

A dermatologist described the issue on Newsmax in August, 2017:

Part of the healthcare reform imposed by President Obama was a series of mandates (with associated penalties for lack of compliance) that forced physicians to switch to electronic medical records. This was problematic from a variety of perspectives not the least of which is one is that this may be a violation of free speech (how you record your interaction with a patient should be decided by you and your patients). Instead, physicians and hospitals were forced to pay for the implementation of systems that in many cases were not ready for prime time. The companies that made this software reaped the benefits of this regulatory bonanza while healthcare providers and patients had to sort out the nuances of each interaction. Instead of focusing on the patient history, physicians were forced to focus on recording information mandated by their software. The flavor of each interaction was lost as each person became a series of boxes to check during a visit that became less and less personal.

Now, we discover that physicians are increasingly feeling burned out. They are stressed out and exhausted… thinking about leaving medicine or even contemplating suicide. The New York Post reports on the problem. Few other media outlets have noted this unwanted side-effect of Obamacare:

Doctor burnout is becoming a huge problem, according to new research, which finds that nearly half of all physicians feel completely depleted, to the point where one in seven have contemplated suicide.

The annual Medscape report, released Wednesday, finds that on average, 44 percent of the medical professionals your existence depends on report feeling stressed out to the point where they’ve considered leaving the field altogether.

A higher percentage of these wiped-out life-savers are women, according to the survey of more than 15,000 doctors.

“It’s alarming,” says Brunilda Nazario, lead medical director at WebMD, which owns Medscape. “These numbers haven’t changed, and the problem just continues to be a trend, despite increasing programs to address wellness,” such as “nutrition and exercise programs, or more time off.”

Evidently, a burnt-out physician is an ineffective physician. As for the reason why the situation has become so bad, everyone seems to agree that the culprit is the Obamacare mandate for electronic record keeping:

The reason for the scary numbers isn’t what you would think: Most doctors say it’s the level of paperwork and data input they’ve had to do since medical records went digital. Doctors end up spending about 45 minutes per patient visit on tasks like “inputting data codes for the visit,” Nazario says, leaving little face-to-face time with patients.

“[Doctors] are spending an enormous amount of time taking in data during physician-patient visits,” she says. “I know during my last visit for my physician, I think the doctor spent no more than two minutes looking at me. They were looking at a computer screen.”

More time keeping records means less time with every patient.

The result is scary: “I dread coming to work,” one neurologist says in the report.

A family physician says the stress is taking a toll on her physically: “I’m having recurrent miscarriages.”

“I’m drinking more and have become less active,” an anesthesiologist says.

Though most doctors say the depression doesn’t affect their patient care, 35 percent say they find themselves getting exasperated with their patients, and 14 percent say they make errors they wouldn’t normally make.

So, a seemingly great idea has produced some seriously unintended consequences. Somehow or other the great minds who produced Obamacare did not factor in the time and effort that it would take for physicians to keep up with mandated record keeping.

The Post article explains:

… all the schooling and training they’ve undergone can feel like a waste when most of their day is spent typing codes into their medical software.


JPL17 said...

From the time I left my parents' house at age 18 until the implementation of Obamacare in 2014 -- a period of 45 years -- I didn't lose a single primary care doctor due to retirement from private practice of medicine.

Then, from the full implementation of Obamacare in 2014 until today -- a period of barely 5 years -- I've lost 2. Both were young and healthy. Both were driven insane by the record-keeping and other mandates of Obamacare. How long till the same happens to my current doctor?

Meanwhile, of course, both the premiums and deductibles on my and my wife's private market individual health care plan tripled, leaving us paying 35% of our household income on premiums and deductibles before we could see a penny of benefits from our new Obamacare-compliant plan.

So thanks, Obama, for forcing me to pay premiums I can't afford, for insurance I can't use, to see doctors who leave practice every 2-1/2 years.

trigger warning said...

Speaking of codes, if you ever wondered why Dr Welby doesn't make house calls anymore, there's no code for house calls. So the good doctor can't get paid. And the codes themselves have reached - and passed - the point of absurdity. For example, under the "external causes of morbidity - exposure to animate mechanical forces" category, there are nine different codes for "contact with a parrot" (W61.0), ranging from bitten, struck, and "other", detailing initial and subsequent encounters as well as sequelae. There are also different codes for macaws, chickens, turkeys, ducks, etc.

The old cliché seems to apply: physicians are being nibbled to death by ducks.

"Thank you, Obama."
--- Barack "Lightworker" Obama

Ares Olympus said...

I've heard similar laments in the world of teaching, and even friend who was a headstart teacher says she was spending more time with paperwork than with the kids, although she might have been exaggerating, it obviously wasn't what she wanted to spend her time on, and she just imagined it never read, but going into files somewhere to die.

Exploding bureaucracy always needs more paperwork, or now computer work, to gather statistics, measure anything that justify billings and to be able to pretend things are being managed.

Perhaps if enough doctors are willing to leave, we'll have a shortage, and then they'll have more leverage to say they're not going to do things that don't clearly help their patients.

trigger warning said...

"Perhaps if enough doctors are willing to leave, we'll have a shortage, and then they'll have more leverage..."

Naturally, if enough doctors leave and a shortage ensues, as Democrats are prone to say, "People will die." In engineering parlance, this is called "destructive testing", or "testing to failure". It reveals a mindset common among People of the Left and Leftist regimes, as it's an excellent, low-cost test protocol for mass-produced objects of low value; the cost of destroying a few is negligible.

sestamibi said...

And yet we continue to fill our med schools up with female students who will either burnout or, if they actually do manage to find a mate worthy of their superior intellect and status and actually do manage to bear a couple of kids, will take 5-7 years out of their precious career time to raise them. That is time that could have been used to treat patients, and space taken up in a med school that could have gone to a male student not burdened by such issues.

Anonymous said...

sestamibi, you have touched on a very important aspect of current trends. It was reported in a British newspaper a few years ago, that the increase of female doctors presented the vary problems you mention. They also tend to marry so they can take off or work part time.

DocVinny said...

My career before medicine was computer engineering. Much of that time was spent convincing clients to not try to make a computer do things it's not good at. Medical charting is once of those things.

Go back before this idiocy, and the average consult was one page long. Now an urgent care visit for a hangnail generates an eight page note.

As a computer engineer who now practices medicine, I'm a big believer in charting on dead trees (meaning paper)

I stay in medicine to protect the people I care about from what they've turned medicine into.

Anonymous said...

Where I work, the docs have become so much less efficient and burned out from the electronic charting that they leave or retire early. The ones that stay see fewer patients than pre - electronic charting because it slows them down so much. As a result, the healthcare corp that they work for cuts their salary and benefits down almost to where the ARNP's and PA's are, and then hires more ARNP's and PA's to do all the primary patient care, because they'll work for less pay. This is the first step of socialized medicine and was the aim of Obamacare, i.e. drive the experts out and hire others with a fraction of the expertise to deliver a fraction of the care at less cost. I suspect that the MD's with paper charting, and their far more expansive medical knowledge, were far more cost efficient to the whole system as gatekeepers than the ARNP's and PA's are with the EMR.

Galway Boy said...

Let’s look at this from the other side too.

When I was at the doctor’s office last week, I was asked the same endless stream of questions that I was asked a week before, two weeks before that, a month before that and every f’ing time I set foot in there. I don’t smoke and I never have yet I’m asked that every time. I live at the same address, have the same insurance, same emergency contact that Ive had for years. My medical history has not changed. I have to report the same surgeries, same previous hospitalizations, same historic conditions, same medications, same family history time after time after time as though it was never recorded. Instead of asking me this every time, look at the f’ing page in front of you. Quit wasting time, yours and mine.