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Five things doctors want

Filed by KOSU News in Public Insight Network.
February 7, 2013

Americans trust their health care providers above all others professionals. You can check out the numbers straight from Gallup if you don’t believe me (and yes, I see where journalists rank).

Medscape Physician Satisfaction Survey 2012

Job satisfaction by specialty among over 24,000 doctors surveyed by Medscape/WebMD in 2012. (From Medscape’s Physician Compensation Report, April 2012)

Despite the trust of their patients, doctors seem to be less satisfied with their jobs than ever before. Only 54 percent of more than 24,000 doctors surveyed by Medscape/WebMD in February 2012 said they’d choose medicine if they got to start their careers over again — down from 69 percent in 2011. So we recently asked doctors to tell us what would make their jobs — and lives — better.

No one who responded asked for new medical equipment or gadgets. Instead, doctors wrote to us about reining in defensive medicine — a practice of making medical decisions with the intention of avoiding lawsuits rather than working in the best interest of patients. They also griped about electronic health records, which the Affordable Care Act kicked into high gear starting Oct. 1, 2012.

But more than anything else, doctors in the Public Insight Network told us they need more time — time to talk with patients, time to think through difficult diagnoses, time to analyze data showing whether patients are doing better under their care — and fair compensation for that time.

Here are five things doctors told us would transform the way they practice medicine:

1. Time with patients

“If I could have 30-minute visits with patients who have more than one urgent issue to address, that would thrill me,” wrote Dr. Holly Biola, who practices family medicine in Durham, N.C.  ”I could get to necessary preventive conversations like obesity [and] weight loss, smoking cessation, adult vaccinations, alcohol/drug overuse/use screening, cancer screenings, etc., without feeling like I was ‘holding up the works.’”

Lancaster, Pa., pediatrician Dr. Melissa Tribuzio agrees:

“Our society is so mobile that most parents don’t have an extended family to rely on for advice. And those that do are often given outdated information by well-meaning loved ones. Others find inaccurate information on the Internet.

“I would LOVE more time to spend explaining why I am prescribing a certain medication, and sometimes more importantly, why I’m not. Or why 18-month-olds hate socks. Or how to not fight over vegetables. Or why I am sure the child has a cold and not meningitis.

“Compliance has been shown to significantly increase when patients feel that their provider has really heard their concerns and addressed them. Knowledge is power, and we need to fix the power gap between providers and patients.”

And time doesn’t have to be face to face. Dr. Faisal Qazi, a neurologist in Chino Hills, Calif., says he could improve patient outcomes, comfort and care through discussions over the phone — if insurers paid for that time.

2. Compensation for using their brains

Dr. Samuel Hunter of Franklin, Tenn., asks for “adequate pay for cognitive work with sick patients and the unbelievable paperwork they require. It costs far more than we are getting paid.” Dr. Hunter, a neurologist who has been in practice more than 20 years, adds, “I am going to quit if I can’t get it. People will die because they have no one to pick up the ball for serious, chronic, neurological disease.”

Dr. James Ledbetter also wants to be paid for the “cerebral work” he does — in the same way other doctors are paid for their procedural skills. The Portland, Ore., doctor specializes in developmental pediatrics. “My expertise allows me to avoid intrusive tests and procedures in children,” he says, “but I am compensated for the complexity of my patients, based upon the number of tests and procedures ordered — not based upon the amount of history I need to review and assimilate, coupled with an in-depth physical and neurological examination and the significant amount of time required for each child to accomplish this.”

For Dr. Tanvir Hussain, a cardiologist in Beverly Hills, Calif., more time would allow him to stay current with the latest medical research that is supposed to guide his practice:

“Over the past 10 years we have made a shift fully to ‘evidence-based medicine.’ The idea is that we will no longer treat based on what we know in physiology, but treat based on research-based outcomes (heart attack, death rates, etc.).

“Keeping up is the hardest thing to do for an independent practitioner. … Too much information comes at you too fast, and with everything else on our plate it feels impossible to keep up with new findings and research.”

3. Less “mindless” documentation

“I spend about 50 percent of my clinic time typing,” says Seattle orthopedic surgeon Dr. Paul Manner. “Most of this is tangential at best to what I actually do for the patient. If we’re trusted enough to see patients, we should be trusted enough to be able to bypass meaningless documentation. We have been turned into high-priced stenographers.”

4. Or: Time to make good use of required documentation

Holly Biola, the family doctor from North Carolina, says she wishes all primary care physicians had office time set aside to review their performance on quality measures and to figure out how they can improve.

“The electronic medical record (EMR), for most of us, has just meant taking more work home. Most primary care offices do not have the time or staff to dig into the real meat of the population health metrics and quality measures that EMRs should allow us all to look at.

“The expectations (in terms of number of patients to see per day) on primary care docs are so high. Just finishing up documentation of the visit, and then following up on the results of the abnormal cholesterol tests, abnormal paps, abnormal mammograms, abnormal kidney and liver function tests, etc. after the appointments are over — all of that takes so much time outside of the office visits that I can barely see my family, get my rest and exercise.

“What I would like is time to look at how I am doing and how I could do it better. None of the insurers pay for that.”

5. A better way to pay for health care

Doctors differed in how they’d tackle this issue. Some argued for universal health care; one wrote that everyone should have a health savings account (HSA) from birth so we’d be more responsible about how we choose to spend our health care dollars. Others just want to spend less time dealing with insurers.

“Practicing medicine in 2013 is 50 percent about working with insurance companies,”  Melissa Tribuzio, the pediatrician from Pennsylvania, says. “I spend half of my day filling out paperwork of some sort to convince an insurance company to pay for a medicine or a test or a treatment.”

Dr. Elaine Marcus is a family physician who works at an urgent care clinic in Portland, Ore. She says universal health care would cut down on the hassle she runs into with insurers, and would also give her patients better care:

“I would be able to send people to orthopedists with fractures, to neurologists with strokes, or to gastroenterologists with intestinal bleeding, and they would get the appointments without having to pay hundreds of dollars up front.

“I would also know, for every patient, what the procedure is for getting approval for tests or treatments, instead of my staff having to call the specific insuring entity before a test or specialty appointment can be scheduled.”

Ditto, says Dr. Arlyn LaBair of Denver, who now does mostly hospice and palliative care: “Having to adjust care based on the payment system for each patient encounter is a real time sink!” With a single-payer system, she says, “I could practice medicine, not accounting.”

Psychiatrist Dr. Julia Frank of Silver Spring, Md., no longer sees the patients that she thinks could most benefit from her skills:

“After years of being cheated by insurance companies, we only see patients able to pay up front and pursue reimbursement from insurance companies.

“Under these circumstances, I must specialize in conditions of the moderately wealthy, not those for which I have special interest and expertise. If I could practice embedded in a general medicine clinic, rather than under ‘mental health carveout’ conditions, I could do much more good than I do right now.”

So now we know a little more about what goes on in our doctors’ worlds beyond the exam room. And it doesn’t seem as though there’s a whole lot that patients can do to provide any of the things doctors above said they want — though patients can offer a little empathy during those rushed visits and long waits.  But one additional request doctors made that patients do have some control over is taking personal responsibility for health and health care.  We will be talking to doctors and patients about where responsibility and health intersect soon.

>> In the meantime, what about your job? What would help you do your job better?  We’re taking your requests here.



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