Monthly Archives: March 2017

Note to Congress–You Reap What You Sow—Massive Physician Shortages Predicted by 2030

 

Dr Kevin R. Campbell

Cardiologist and CEO, K-Roc Consulting LLC

When you go to the internet or phonebook today, there are hundreds of physicians listed in most urban areas. In the next two decades, you can expect more difficulty finding a physician in your hometown– a major physician shortage is looming.

In the last year, I have noted many mid career physicians leaving the practice of medicine. While the growth of mid level hospital administrators has ballooned at nearly 3000%, fewer students are entering medical school. In fact, according to Compdata surveys, hospital administrators now account for a large proportion of the costs of healthcare.

The pending physician shortage will affect both primary care as well as numerous essential subspecialties. When I was in medical school, I was told that specialists—such as cardiologists—would be in abundance and I would not be able to get a job. I have been a practicing cardiologist for almost 17 years now. Based on the current report it is expected that we will see a shortfall of nearly 100K doctors by the year 203. A closer look at the predictions show that we will have a shortage of 40K physicians in the critical area of primary care as well as a shortage of nearly 60K physicians in specialties such as allergy and immunology, cardiology, gastroenterology, and infectious disease. In general surgery, the report predicts that there will be 30K fewer surgeons than are needed to provide care to those who need it.

Why Are Doctors Leaving Medicine?

A 2016 report from the Physicians Foundation found an alarming growth in burnout and dissatisfaction among practicing physicians—47% of respondents in the survey indicated plans to “accelerate” their retirement and move into areas outside of clinical medicine. The most common reason for leaving medicine included regulatory burdens and electronic health records. Nearly 63% indicated that they have negative feelings about the future of healthcare and only half of all physicians would actually recommend a career in medicine to their children. Many of my colleagues feel that they have no voice and have no way to impact healthcare policy—even in their own institution.   As regulatory requirements and non clinical tasks continue to mount, physicians are finding themselves spending less and less time with patients. According to 2016 research from the Annals of Internal Medicine, most doctors only spend 25% of their day engaging with patients—the bulk of the time is spent on non-clinical electronic and regulatory paperwork. IN fact, for every hour of direct patient contact, physicians have and additional 2 hours on electronic paperwork.

What is the Solution?

These statistics should be incredibly troubling for all Americans seeking healthcare. With access already an issue in the US healthcare system for many and more reforms on the way, we must do more to entice bright young minds to medicine—and retain those that are currently delivering care to millions of patients.

While the AAMC (American Association of Medical Colleges) argues that the answer to averting a shortage lies in creating more training spots and allowing advanced practice nurses and Physician Assistants to do the work of trained physicians—I would argue that the real answer to the pending physician shortage crisis—unfortunately–lies in Washington DC. Congress must act to save healthcare.

  1. Limit Meaningless Electronic Paperwork

Currently doctors spend far too much time with electronic medical records EMR). The EMR, while touted to be a patient safety tool is nothing more than a way for hospitals and healthcare systems to ensure that they are billing patients at the highest levels—capturing all possible charges. Physicians are forced to click through a myriad of pathways in the record in order to document their care and work and all of these pathways are carefully designed to maximize billing codes. Most doctors take home 2 or more hours of electronic documentation nightly in order to keep up with patient care loads. We must streamline paperwork and balance documentation with patient care. Doctors should not be billers and coders for the healthcare system.

  1. Remove Hospital Administrators from the Care Equation

In some institutions, there are more mid level managers than physicians. These executives are not physicians and are not trained in the practice of medicine. Their primary focus is to increase market share for the healthcare system and to “manage” healthcare professionals by creating algorithms of care and regulations. Administrators will claim that their activities will help with quality improvement and patient safety. However, most of these individuals are highly compensated and I am not aware of any data that suggests that their activities have ever been shown to improve patient outcomes. For most physicians, administrators are a mechanism for increasing cost of care. Physicians should be part of the decision making process in any healthcare system and should have a voice—currently there are very few physicians in the C-suite.

  1. Remove Barriers to Patient Care

Nothing frustrates doctors more than not being able to provide care to patients. We must make healthcare more accessible and provide physicians with the resources they need to efficiently provide high quality affordable care. We must promote the use of telemedicine and digital tools to enhance the doctor patient interaction. We must allow physicians and patients to build long term relationships and facilitate and promote engagement. No longer can we allow networks and insurers to dictate which doctor a patient can see—“if you like your doctor, you can keep him/her. “

  1. No Longer Allow Insurance Companies to Dictate Care

As a practicing physician, I spend a great deal of time battling with insurance companies over appropriate care for my patients. I find myself spending hours each week on the phone with an insurance company bureaucrat arguing that a particular test or therapy is indicated (even though these are supported by clinical guidelines) rather than caring for patients. We must not allow insurers to dictate how highly trained physicians should care for their patients. Insurers must abide by the practice guidelines and indications for tests and procedures that have been approved by major national organizations such as the American College of Cardiology, for example.

 

 

 

There Is No Need to Make a Choice, Representative Chaffetz: Mobile Phones ARE The Future of Healthcare—

This past week Utah Republican Jason Chaffetz made comments concerning healthcare reform that illustrates JUST how out of touch Congress is with modern medicine. In a press conference addressing the ongoing debate over Obamacare repeal, he stated that Americans should make a choice between purchasing health insurance and an iPhone—in the Congressman’s own words “rather than getting that new iPhone that they just love…Americans should invest…in their own healthcare.” As expected, Chaffetz was met with sharp criticism for comparing the cost of a phone to the cost of healthcare. However, I think that most everyone missed the real fallacy in his statement—iPhones and other mobile devices can be a real asset to managing chronic disease and ARE now beginning to be an integral part of healthcare. Rep Chaffetz should learn more about healthcare before he and his colleagues begin to try to create sweeping reform. For instance—ask doctors and patients what is most important to THEM and work WITH us to create meaningful reform. Statements such as the iPhone comments demonstrate JUST how LITTLE Congress really knows about the nuts and bolts of healthcare.

The Digital Revolution in Healthcare: Improving Outcomes and Cutting Costs

Engaging patients in their own care through individual accountability—a sentiment that Rep Chaffetz actually got right (in a roundabout way)—has been shown to improve outcomes. When patients actively participate in their own healthcare and understand the goals of therapy, they tend to experience fewer hospitalizations and fewer complications related to their chronic diseases. Fewer hospitalizations and fewer complications result in much lower healthcare costs.

Physicians are now prescribing apps for tracking blood pressure, activity, heart rate and blood pressure—just to name a few. Other applications such as MyRxProfile are being used to help patients monitor for adverse drug interactions—a leading cause of Emergency Room visits in patients over the age of 65. All of these applications can potentially help patients and physicians focus on PREVENTION—ultimately saving healthcare dollars. New devices are being created every single day to incorporate smartphones into collecting important medical and biologic data. For example, the AliveCor device allows patients to get a real time Electrocardiogram (EKG) simply by touching their fingertips to and electrode that is installed on their smartphone—often obviating the need for an ER visit or hospitalization. Apple’s Health Kit is now being used to help encourage medical app development and to collect important health and wellness data. In addition, Apple’s Research Kit is being used for important groundbreaking medical research by several leading academic medical centers across the United States. Patients are more internet-savvy and many come well prepared to office visits armed with information obtained from the internet. According to the Pew research center, nearly 75% of all patients go to the internet either before or after a visit with their healthcare provider. These patients—now called “e-patients” are well connected, well informed and digitally proficient in the healthcare space.

So Rep Chaffetz, Learn from Doctors and Patients—iPhones are PART of Healthcare…

It is my hope that Congress—both Republicans and Democrats–will stop the fighting and political posturing and do their jobs. They must stop grandstanding and making daily speeches aimed at providing soundbites and creating a media buzz. EVERYONE in Congress must work together to create legislation that will provide high quality, affordable and accessible healthcare for all Americans. There is no longer any place for comments such as those from Chaffetz and his colleagues in a discussion of meaningful reform. We must embrace technology and promote its use among our patients. As doctors become increasingly overwhelmed by paperwork and other mandated clerical activities, it is essential that we continue to develop digital tools to assist and engage patients in the management of their diseases. SO, in my view, you should be able to have your healthcare….and your iPhone too!

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