Monday, September 10, 2012

Time as the Culprit of Primary Care Burnout and Patient Unhappiness: A Sad Story

One cannot rent, hire, buy, or otherwise obtain more time.  Time is totally perishable and cannot be stored. Yesterday’s time is gone forever and will never come back. Time is,  therefore, always in esceedingly short supply.…The supply of time is totally inelastic.. Time is totally irreplaceable.”
Peter F. Drucker (1909-2006), The Effective Executive
This is the saddest story I have ever heard.
Ford Madox Ford (1873-1939), The Good Soldier
September 10, 2012 – The story of Rob Lamberts, a primary care physician practicing somewhere in the Southeastern United States.  is sad.  Because of time demands imposed  by 3rd party payers, Lambert feels he no longer has time to spend with patients.  Therefore, In a September 10 post in The Health Care Blog,  he announces he is “dropping out “ out of his current partnership practice to establish a solo practice.
Lambert says he is leaving his partners to set up up a practice that does not file insurance.  He will take a modest “subscription fee,”  to devote more time with patients and allow them more access to services.  He maintains his new practice will not follow the concierge model,  for his fees,which have yet to be estalbished, will be much lower and will not impose a financial burden on his patients.
The story is sad  becasue Doctor Lamberts has been a “a good soldier,” a relentless innovator who adopted electronic medical record 16 years ago. He has sought to follow the quality care dictates of outside reformers and payers  by  setting standards of what primary care ought to be.
Doctor Lambert gives these reasons for dropping out:
1.       He doesn’t feel he can any longer give patients the time they deserve.

2.       Given time constraints, he cannot make sufficient money to pay for his kids' education or to get simple things done, like fixing the windshield wiper on his car.

3.       Nor does he have time to cope with nonpatient issues – entering codes in all of his notes, dealing with paperwork, handling drug formulary issues, and practicing defensive medicine to avoid malpractice.
By dropping out of 3rd party arrangements he hopes to cut his overhead and free up time, and in the process.
1.       keep the cost of his services reasonable;

2.       keep his patient volume reasonable (1000 patients rather than 3000);

3.       keep patients out the ER and hospital and out of the hands of expensive specialists;

4.       have time to communicate with patients through e-mail and texting;

5.       Help patients keep their own medical records;

6.       form a more cooperative relationship with his patients.
Doctor Lambert wants a practice “where I can take better care of my patients while not being burned out in the process.” Besides,  he adds, it will be a relief,  "to change from  being a nail, constantly pounded by an unreasonable system,   to being a hammer.” 
Lack of time with doctors is a  leading cause of patient frustration.  Like doctors, patients  have a limited amount of time. They rightfully complain of spending too much time twiddling their thumbs and staring at the ceiling in the reception lounge or examining room, impatiently waiting to see an overworked physician with not enough time for them.
Perhaps the primary care physician of the future will have more time for patients.  Primary care visionaries are beginning to address misuse of time issues. This is evident in  this paragraph in an article “The Developing Vision of Primary Care” in the September 6 New England Journal of Medicine.
“No longer would the physician run from room to room, pushed by the clock and the paycheck. Reimbursed through global payments linking hospitals to primary care practices, the physician, too, would have a financial incentive to keep patients healthy and to prioritize services with that goal in mind. The physician would now see fewer patients in the office, leaving time for responding to questions e-mailed by patients the previous night and for calling those who would otherwise be headed to the emergency department. Clinic visits would ideally be nearly twice as long as they are now, since physicians would focus on patients with complex conditions and would have time to address care coordination, answer patients' questions fully, and understand their personal health goals in order to guide treatment. Timely follow-up after hospital discharge would be a high priority, and some visit slots would be reserved for that purpose of Primary Care.”
So much for a future scenario of they way things out to be .  We are not there yet.  Until the system recognizes that lack and misuse of time contribute to primary care burnout by wasting the primary car physician's  time, training,  and talent, we shall have a growing shortage of primary care physicians.
Tweet:  Lack of time to spend with patients, due to paperwork and regulatory demands,  is a prominent cause of primary care physician burnout.


guest posting said...

Time is a dimension in which events can be ordered from the past through the present into the future, and also the measure of durations of events and the intervals ...

Richard L. Reece, MD said...

This sounds profound but I do not know what it means when applied to primary care physicians. Please explain.

Unknown said...

There does seem to be a sense of exhaustion in the healthcare industry. It's as if doctors and patients have become nihilistic drones. Doctors are tired and forced to produce results rather than treat. Patients expect this from doctors, so they go into their office half-hearted. Out of curiosity, do you feel as though the implementation of electronic medical records technologies will help or hinder physicians in terms of patient time?