At the end of every year, Medical Economics publishes a list of the top challenges facing physicians. This list is generated by surveying our physician readers.
For this year’s list, we decided to recast the question. Instead of asking what challenges physicians face, our editorial staff wanted to hone in on what issues annoy and frustrate doctors and get in the way of what’s truly important: Treating patients and running practices.
And so we asked physicians in a poll: “What ruining medicine for physicians?”
In our list of the nine issues ruining medicine for physicians, the goal is not to dwell on the negative aspects of working as a physician. Instead, we wanted to show our readers that they share common challenges when dealing with the vexing issues facing primary care in today’s complex healthcare environment. Each piece also offers practical solutions that physicians can start using in their practices today.
#1 Paperwork and administrative burdens
It’s no surprise that physicians chose paperwork and administrative burdens as the top issue ruining medicine. Earlier this year, in the 2018 Medical Economics Physician Report, 79 percent of doctors said it was the top challenge they experience in practice.
Much of this burden is a result of changes in the last several years, notably the advent of value-based care.
Kevin Riddleberger, MBA, cofounder and chief strategy officer at DispatchHealth, which delivers mobile urgent care to homes, says paperwork or administrative duties is not the best use of clinicians’ time and resources, and directly impacts patient care and increases physician burnout.
Kyle Varner, MD, an internist at the Tripler Army Medical Center in Hawaii and author of White Coat Cartels, laments that he spends more time in front of a computer documenting his time with patients than he actually spends with patients.
“This is not because I am trying to create a good record of the care—it is because I have to play semantic games so that the hospital gets paid,” he says.
Then when records come in from another hospital, often he must sift through hundreds of pages of data to find the important information he needs, saying it is hidden in a pile bureaucratically mandated auto-populated junk that no one wants to read.
Another challenge is dealing with insurance companies that try to convince him to prescribe certain drugs over others, citing a longer authorization process and lots of paperwork for his preferred choice in many cases.
“So, instead, I often adhere to their guidelines, which may not have the patient’s best interests at heart,” Varner says.
He cites the example of trying to get a Medicaid patient on sacubitril/valsartan (Entresto), a drug used to treat heart failure.
“I can expect to spend at least 45 minutes filing paperwork and I can expect to get multiple phone calls when I do this,” he says. Because of the extra time needed, he feels Entresto isn’t prescribed as much as it should be, blaming the indirect incentives created by third-party payers.
C. Nicole Swiner, MD, with Durham Family Medicine in Durham, N.C., says physicians are often in a tug-of-war between what is right for their patients’ care, what the patient’s insurance will cover and what the pharmaceutical companies will allow them to prescribe.
“Specialists are also still valued more than primary care providers, yet PCPs are underpaid and overwhelmed with work,” she says. “I or my staff members spend the majority of our weeks on the phone and doing paperwork (often denied and resent having to do again) on our patients’ behalf for better care.”
Even students and residents can’t escape busy work. Internal medicine residents spend just 12 percent of their time with patients and 40 percent on computer-related tasks or administrative tasks, according to a study out of The Johns Hopkins University School of Medicine.
Ways to overcome the challenge
There’s no magic solution for eliminating paperwork or administrative burdens. But there are some ways physicians can ease the burden on themselves and their patients.
Have patients pay cash for medications: Varner frequently suggests that patients whose insurance company requires prior authorization take this route because it will simplify the process. “This is usually substantially cheaper than they think,” he says. For example, when one of his patients was told by Medicaid that he couldn’t have Linezolid without a pre-approval process, Verner got the patient a coupon so he could get the medication for just $50.
Rely on technology: Riddleberger says the future of healthcare operations and clinical delivery will improve thanks to enhancements to technology that will decrease paperwork and administrative burdens. Some of what’s expected to help are increased machine learning, natural language processing and artificial intelligence in day-to-day care delivery.