Letters: Readers comment on Medical Economics stories

October 22, 2010

Letter and response whether doctors over the age of 60 will see the benefits of implementation of electronic health records prior to retirement.

Docs over 60 may not see EHR benefits before retiring

When I turned 60 years old 4 years ago, I ran the numbers and decided the few certified electronic health records (EHRs) were too costly for me to justify adding to my practice. I've also been e-prescribing long enough to realize that you can make mistakes a pharmacist won't catch-refilling Miralax instead of Mirapex, for example.

Many doctors over the age of 60 who had hoped to work until close to age 70 are faced with paying our staff in the face of Medicare fee freezes and delays, and many of us simply will not practice long enough to amortize the price of a system that will benefit insurers as much as patients.

I'm not denying the potential benefits of healthcare information technology; I'm just pointing out that it's not free, takes time, and the proven benefits are a bit more marginal than proponents would have us believe.

Now, on the downhill slope to 65, I'm happy to see technology being adapted and partially subsidized by Medicare. Maybe if other insurers chipped in, more of us would come aboard. But when Medicare mandates EHRs a significant number of older primary care physicians in small towns will hang it up.

Medicare may be forced to offer bonus payments to doctors over the age of 60 who agree to hang in-paper charts and all-until there are enough family nurse practitioners at Walmart to provide primary care.

CHARLES DAVANT, MD
Blowing Rock, North Carolina

Dr. Scherger responds: Keeping better medical records does take time compared with dreadful handwriting that few people can read. Dictation is very expensive, and EHRs are actually cheaper than dictation in the long run. Most users of EHRs become time neutral after a couple months of using the system.

I live by the 5- and 10-minute rules. Any follow-up note should take me 5 minutes or less, and a new patient or comprehensive note should take me 10 minutes or less. Quality charting deserves that. Of course, if you try to see 6 patients every hour, you will have little time for keeping quality records.

Boards are not flawed

Dr. Edward Volpintesta questions the need for ongoing assessment of physician competence, arguing that a physician's competence or lack thereof can be ascertained during residency and not after it ("Boards are flawed" [Talk Back], August 20 issue). The evidence, however, says otherwise. A growing body of research highlights the fact that physician knowledge and skills deteriorate over time-including a study published in August in Health Affairs (http://www.ncbi.nlm.nih.gov/pubmed/20679648?dopt=Abstract).

In addition, Dr. Volpintesta must not be familiar with the current maintenance of certification (MOC) program. MOC provides a framework for learning and assessment; and it is not just a pass/fail approach. MOC gives physicians the opportunity to address weaknesses in their practices through the practice assessment requirement. Looking at their own practice data, physicians determine an area that needs improvement and implement an improvement plan. Nearly three-quarters of physicians in the American Board of Internal Medicine MOC program who have done one of our practice improvement modules have changed their practices as a result of what they learned. We would welcome Dr. Volpintesta into the MOC program so he can see how it has evolved over the years.

CHRISTINE CASSEL, MD
PRESIDENT & CEO
AMERICAN BOARD OF INTERNAL MEDICINE
Philadelphia, Pennsylvania