Keith Martin

By its own account, the federal government has spent more than $35 billion to get the nation’s physicians to use and share data via EHRs. Yet, it continues to be thwarted by technology that retails for less than $100: the fax machine.

CMS Administrator Seema Verma said recently that EHR technology is making physicians’ work harder, causing more burnout. As a result, physicians are turning to fax machines as the next best thing to share data.

Yes, that staple of the 1980s remains more technologically consistent for some physicians than the sleek, drop-down menu-driven software CMS and other agencies have banked on to revolutionize healthcare. And it’s this subset of medical Luddites that’s causing a thorn in the side of regulators. So much so that Verma gave health IT developers a mission: “Help us make every doctor’s office in America a fax-free zone by 2020,” she said, speaking at a recent ONC Interoperability Forum in Washington, D.C.

Now here’s what Verma means: It’s 2018. We do everything on smartphones from detailed records of every morsel of what we’ve eaten this week to how many steps we’ve taken. But in healthcare, our healers would rather figure out whether you transmit a paper record face up or face down in a fax machine than utilize our $35 billion investment. Let’s get to interoperability.

Verma touted a future featuring a truly interoperable healthcare system where patients can access records at any time and physicians can communicate effectively and efficiently.

“The reality is that once information is freely flowing from the patient to the provider, the advances in coordinated, value-based and patient-centric care will be even greater than anything we can imagine today,” she said.

Who can blame physicians for using tried-and-true communication that has served them well for years? It doesn’t make them “old school” or non-believers in technology, it makes them smart doctors. They don’t spend time on the phone with customer support, develop work-arounds to make the tool work for them, and they don’t spend thousands a year to maintain their fax machines.

Physicians are intelligent group. Until interoperability becomes a reality, they will use all tools at their disposal to effectively treat their patients. If the end of the fax machine means the dawn of true EHR interoperability, they’ll be the first one to turn in their ink cartridges.

But until the government can stop talking about interoperable systems and make them a reality, a “send” button may be the least stressful option for many of the nation’s physicians.

Articles

The next big EHR interoperability idea? 

Thanks to an anonymous $3 million donation, the inaugural class of the University of Houston's medical school will not have to worry about their tuition. The school, established last year, will focus on primary care education.

If only every doctor were as lucky as these 30 budding physicians.

, three in 10 physicians complete their education with more than $200,000 in debt.

That’s quite a burden for someone starting a new career in healthcare. Our data also indicate a similar number (31 percent) say their level of debt determined their employment path in medicine. It’s not a stretch to think that opening a practice with your name on the door is a far-off dream when calculating debt repayment.

That’s bad for many physicians who have a knack for being an entrepreneur, but lack the financial means. It also negatively affects those who decide not to go into primary care and instead choose specialty medicine which can reduce their debt in a shorter amount of time.

Medical students have told me they were dissuaded from going into family or internal medicine by professors, who describe a life of long hours, low pay, and administrative nightmares. These same students hear that sacrificing autonomy to work for a hospital or health system is a small price to pay compared with doubling the time it takes to pay back loans by going independent or joining a new practice.

We must drive eager young students toward primary care, not away from it. This includes making more programs such as scholarships and debt forgiveness a reality for tomorrow’s physicians.

In this issue, you’ll read more about how physicians overcame their educational (and other) debt burdens to focus solely on medicine, including several great programs to reward primary care physicians for their choice of specialty and the location of their practice. There are lots of opportunities out there, but we need many more, and soon.

Burnout is claiming some of primary care’s best and brightest. Technology is claiming others who are walking away from the exam room for other avenues to help patients. And if medical debt keeps diverting doctors away from primary care, the projected shortage will grow exponentially.

Medical associations and others should work to increase scholarship opportunities and use their influence to make medical school as affordable for future primary care physicians in any way possible.

Wealthy benefactors are few and far between. Instead of waiting for someone to fix the problem, it’s time to address it today.

If medical debt keeps diverting doctors away from primary care, the projected shortage will grow exponentially.

When debt derails physicians, we all lose

It is a common refrain I heard at a national internal medicine conference addressing the stress today’s physicians face:

“You can’t yoga your way out of burnout.”

I agree. Yoga, meditation, and mindfulness are helpful, but more is required to restore the joy of practicing medicine. These are just some of the ways. There are many more.

The fact is, there is no one-size- fits-all answer to an issue as large as physician burnout. As the stressors vary-from time in front of an EHR vs. face-to-face with a patient to battling payers over the best treatment-so do the means to relieve that tension. But that doesn’t mean it is too much to overcome.

Physicians have numerous allies in this battle, most importantly, their peers. Find strength in their path and their advice.

In this issue, you’ll find examples of numerous doctors who are overcoming and/or preventing burnout from interrupting their core mission of treating patients. And we’d be foolish to believe that readers use this as a handbook, following step-by-step the path of another doctor and expecting the same outcome. But, what we believe we’ve provided are sound strategies to piece together the initial path to improving physician wellness and truly restoring the joy of medicine.

And the other thing we hope becomes clear after reading about peers is that it is OK to ask for help. The stigma around physician burnout-that it is “part of the job” or only happens to weaker individuals-is one of the biggest obstacles to improvement.

Ask for help. Ask a peer how they get back to the heart of treating patients without added, and unnecessary, obstacles. Learn from and listen to one another.

Use this issue as a starting point, as a small step toward taking back a little more of each day to help those who truly need you-whether patients or family and friends. Fight back.

Relief could come in the form of opening a direct primary care practice. Perhaps some simple workflow adjustments free up additional time. It might even be reaching out for some peer-to-peer support and guidance. The solutions are out there, and they are numerous.

And yes, you might even consider a little yoga as well.

The war against physician burnout starts with a strong plan of attack

Patients are taking more control over their healthcare costs. From seeking price transparency for procedures to going online to search for the least expensive prescription, they are firmly in the driver’s seat today.

However, like any driver, proper caution can avoid a major disaster. And right now, the healthcare highway is a dangerous place for many Americans … and it could get worse.

Eight years ago, when the Affordable Care Act became law, the nation’s physicians were introduced to marketplace (or insurance exchange) plans. The goal? To save consumers money by letting them shop for what they believe is the right level of coverage for their healthcare needs at a price they could afford. The power of the healthcare dollar put right in the hands of consumers.

For patients, a less expensive plan often meant higher deductibles, copays, and costs for needed prescriptions. For physicians, tracking plan eligibility was a nightmare, turning them into insurance salesmen, explaining coverage and altering treatment plans. Since then, enrollment has ebbed and flowed, premiums spiked, and costs rose for many seeking coverage.

Fast forward to today and the new “association health plans.” Seen by the Trump Administration as the answer to those Obamacare-induced high prices, the plans allow small businesses to join together to obtain coverage as a de facto single employer.

Many also see this as a way around the administration’s failed attempts to cut essential benefits from required health plans. The nation’s payer association-America’s Health Insurance Plans-warns that consumers may purchase association plans without knowing that they don’t offer these essential benefits.

The American College of Physicians is one of many physician groups that has voiced its concern that cheaper plans may offer fewer benefits.

What could possibly go wrong? I mean, besides destabilizing the insurance markets in some regions, causing premiums to skyrocket, and leaving individuals with large medical bills?

It’s 2018. Healthcare is politics as it was in 2010. That doesn’t mean making the same mistakes under a new name.

Patients-and physicians-deserve much better. All Americans must have better healthcare coverage that meets their financial means. The nation’s doctors need more avenues, not obstacles, to improve patient care. They shouldn’t have to navigate myriad cut-rate plans and find workarounds to much-needed treatment.

Washington, D.C., should be focused on providing better solutions to take care of its citizenry, not fighting over who had the better bad idea.

Patients-and physicians-deserve much better.

Author | Keith Martin

Articles

The next big EHR interoperability idea?

When debt derails physicians, we all lose

The war against physician burnout starts with a strong plan of attack

Cheap healthcare plans much too costly for patients and physicians