Wednesday, April 10, 2013

In a follow up to my previous post about physician burnout, I read this on Medscape recently. As a specialty, we are not doing the worst- ER and Critical care are up there which isn't too surprising given the high-stress job and the long hours.
What I found surprising (and yet not surprising) was that family medicine was up there at number 3.
And then when you look at the causes that the surveys pointed it, it kinda made sense. The top reasons many feel burnt out is the bureaucracy, and the hours spent at work.
Speaking from personal experience, I know the amount of time I spend on paperwork drives me crazy.
Each day I try to squeeze in time between patients to fill out:
  • Prescription refills
  • Prior authorizations (a taboo word for our MAs)- filling out questionaires for the insurance carriers explaining why my patient needs insulin, or calcitriol, or Pill X or Y.
  • Diabetic shoe prescriptions. This one boggles my mind; I'm not a podiatrist. Medschool, residency and fellowship do not train us to decide who needs diabetic shoes and who doesn't. I haven't the foggiest idea if they need "Plastizole inserts" or widened shoes. For that I trust my podiatry colleagues. But for some stupid reason, the Feds have determine that it is the endocrinologist that needs to sign the forms. Even if the podiatrist deems it necessary (but yet in a brilliant ploy- also recently determined that I cannot bill a foot exam if their feet have already been checked by the podiatrist within the last 6 months- but yet they need an endo to examine the feet within a 6 month period)
  • Letters stating why my patient with diabetes on basal-bolus insulin need to check their glucose more than 3 times a day (I don't know which genius sits on the Advisory Commitee for Medicare, but EVERYONE on basal bolus insulin should be testing 4 times a day or more to be safe!)
  • Forms to testify why my patient can do this, or can't do that. From driving, or certain physical activities, to just plain working
  • Letters stating why my patient needs that pituitary MRI
Between my medical assistant and I, we spend 1-2 hours a day on these. So yes, I'm not surprised. I imagine the family doc would have much more than I do
Appears though that other factors were at play. Money being one of them (personally I am not complaining though with the changing climate our office has taken a huge hit in pay in the last fiscal year). Interestingly, the Affordable Care Act  and EMR were listed as number 4 and 5- this certainly has been causing a lot of angst and concern amongst my colleagues. And while many would be surprised by EMR (Electronic Medical Records) as the use of electronic records is supposed to make things better for patient care and physicians, the truth is many systems are prematurely jumping on the bandwagon to tak advantage of the federal stimulus package. And so what happens is medical systems adopt a poorly designed EMR that adds little to patient record keeping (aside from some quality improvement parameters) but instead churns out patient notes that lists 3 pages of diagnoses, medications but has nothing useful at all when it comes to the clinical impression and plan of care. I see this every day, since our system adopted an EMR- I get more asking the patient why they're there to see me, than to read the referral notes that were sent to me. Not to mention learning a new EMR, especially for physicians who are not computer-saavy (but are otherwise excellent clinicians) can be particularly harrowing. I know of at least 3 internists in the area who retired early because of this; they were spending 2 hours every night trying to catch up on documentation.
Anyway, I thought this was an interesting, thought-provoking piece of news. And as if to add more headaches/bureaucratic crap, I received notification from the American Board of Medical Specialties just yesterday that they're changing the way we do our Maintenance of Certification (MOC)- something about needing to do some MOC activities every few years (in addition to our CME requirements every 2 years) and on top of the exams every 10, just to maintain certification. Geez. Something tells me these activities have costs involved, too.
And people wonder why physicians are getting burnt out.
Dear medical student readers: if there is anything I want you to learn from this, look at the first diagram- and consider training in pathology, psychiatry or ophthalmology if you want to be happy!


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