A group called The Physicians’ Foundation came out with yet more evidence (check it out here) supporting what you probably hear from most of the MedBlog community in different forms all the time. If you read my blog regularly, you’re probably also aware of some of my cyber-colleagues like Kevin M.D., Dr. Wes, The Happy Hospitalist, Fat Doctor, Shadowfax and others espousing similar concerns.
We’ve all talked about how primary care is becoming untenable. Now there’s a questionnaire survey that was mailed to every primary care doctor in the country, and it backs up our claims too, essentially asserting:
Primary care medicine sucks if you can’t spend time with your patients.
We didn’t go into medicine (and enormous debt) to do paperwork and argue with insurance companies. People who do paperwork and filing for a living don’t understand our intolerance for their way of life, but it’s a fact that not everyone likes the sterile confines of alphabetization, algorithms and cubicles.
Some argue that the answer is more allied-health providers for primary care, like N.P.’s, Dr. Nurses (weird one, I know), P.A.’s, etc. I disagree. Excellent health systems provide excellent health care, and that starts with well-trained providers with doctorate-level education.
Residency-trained family medicine doctors average 12 THOUSAND hours of training before practice. Nurse Practitioners average around 3500 hours. Same for P.A.’s. These people are easily as intellectually-equipped as doctors, but I think the idea that they are as well trained or can replace physicians is ludicrous.
I also hope lawmakers intent on saving our system don’t rush to the EMR (electronic medical record) as the messiah of American medicine. It isn’t. I use one every day, and it does very little to improve care and absolutely nothing to improve efficiency. If EVERY doctor used an EMR that talked to all other EMR’s, efficiency might improve somewhat. But our capitalist system has provided us with dozens of competing companies and, given our obsession with medical privacy, none of these programs communicate with each other. Digital charting takes hours and is only slightly improved by hacking away on the keyboard during the entire patient encounter, detailing everything as it happens.
And, for a future blog, those records do nothing to protect doctors from litigation. Trust me. Nothing. If anything, they help the plaintiff.
Also on the EMR topic, it is colossally more expensive to sustain than just some basic paper and dictated notes. Companies LOVE the idea of EMR’s because the required tech support, and database maintenance, and program upgrade requirements are virtual gold mines. In the end though, it’s another of thousands of examples of business and enterprise making money on medicine – the real reason American medicine is falling apart.
Like the canary in the coal mine, as Family Medicine goes, so goes American health care. If well-trained doctors are getting out of the business, the natural corollary is that you, over time, will be getting sicker (and poorer).