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Sunday, June 9, 2019

Exploiting Doctors and Nurses

Danielle Ofri, MD, in the New York Times:
…If doctors and nurses clocked out when their paid hours were finished, the effect on patients would be calamitous. Doctors and nurses know this, which is why they don’t shirk. The system knows it, too, and takes advantage.

The demands on medical professionals have escalated relentlessly in the past few decades, without a commensurate expansion of time and resources. For starters, patients are sicker these days. The medical complexity per patient — the number and severity of chronic conditions — has steadily increased, meaning that medical encounters are becoming ever more involved. They typically include more illnesses to treat, more medications to administer, more complications to handle — all in the same-length office or hospital visit.

By far the biggest culprit of the mushrooming workload is the electronic medical record, or E.M.R. It has burrowed its tentacles into every aspect of the health care system.

There are many salutary aspects of the E.M.R., and no one wants to go back to the old days of chasing down lost charts and deciphering inscrutable handwriting. But the data entry is mind-numbing and voluminous. Primary-care doctors spend nearly two hours typing into the E.M.R. for every one hour of direct patient care. Most of us are now putting in hours of additional time each day for the same number of patients.

In a factory, if 30 percent more items were suddenly dropped onto an assembly line, the process would grind to a halt…
Read the entire piece. I've cited Dr. Ofri on numerous occasions and have read her books and articles.

The E.M.R. is now “conveniently available” to log into from home. Many of my colleagues devote their weekends and evenings to the spillover work. They feel they can’t sign off until they’ve documented all the critical details of their patients’ complex medical histories, followed up on all the test results, sorted out all the medication inconsistencies, and responded to all the calls and messages from patients. This does not even include the hours of compliance modules, annual mandates and administrative requirements that they are expected to complete “between patients.”
According to their latest available IRS 990 (2017), the CEO of the Health Information Systems Management Society "non-profit" trade association (HIMSS) is paid about $1.25 million a year. I'm sure he's a very busy person.
As must also be the CEOs of Johnson & Johnson and Pfizer, each of whom earn close to $30 million annually.
The average primary care doc makes about $225k, according to Medscape.


Yeah, it's a decade old. I'm confident that the trend has neither flattened nor reversed.


Monday morning rounds. Saw this cited at The Incidental Economist:

What makes us healthy?

We have an intuitive sense that things like what we eat, how much we exercise, the quality of our water and air, and getting appropriate health care when sick all help us stay healthy, but how much do each of these factors matter?

Studies have also shown that our incomes, education, even racial identity are associated with health — so-called “social determinants of health.”

How much do social determinants matter? How much does the health system improve our health?
Certainly worth following. 'The Drivers."

More to come...

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