New York, NY — I wonder how many students in medical school today are really excited about their future careers? Technology, regulation and new expectations have taken some of the romance out of the profession. They’ve left doctors, nurse practitioners and physicians assistants with new levels of isolation and dissatisfaction, ultimately leading to increased rates of burnout.
Here are some of the clues* we’re watching about new frustrations on the frontlines of medicine:
3 Hours Lost
According to the latest Manhattan Research reports, physicians are spending 2.8 hours of their day slogging through electronic health record entries. It’s work that happens in the exam room (when they’re not making eye contact or physical contact with the patient) + in the office and even at home.
In “A Doctor’s Declaration of Independence,” Dr Daniel Craviotto wrote about the daily struggle:
“I don’t know about other physicians but I am tired—tired of the mandates, tired of outside interference, tired of anything that unnecessarily interferes with the way I practice medicine. No other profession would put up with this kind of scrutiny and coercion from outside forces. The legal profession would not. The labor unions would not. We as physicians continue to plod along and take care of our patients while those on the outside continue to intrude and interfere with the practice of medicine.”
Lots of new medical professionals are entering the practice and fewer and fewer of them are MDs. Instead a growing number of physicians assistants and nurse practitioners are helping those MDs make the medical home model real. They’re each working to the top of their skillsets and then handing a patient off when she needs even more expertise or speciality.
In “The Physician Assistant Will See You,” Barbara Moran looked into this in-practice referral system:
“Like it or not, medicine is now a team sport, observes Dr. Reid B. Blackwelder, president of the American Academy of Family Physicians. As his practice moves to team-based care, he may delegate more well-child visits to P.A.s or nurse practitioners. He enjoys seeing his healthy patients, he said, ‘but the paperwork takes a lot of time — as a physician, my time may be better spent with a patient who is critically ill.’ And he can still keep his relationship with the healthier children, he said, ‘by a quick visit at the end’.”
Verilogue has listened to almost 100,000 conversations between patients and their physicians, hoping to uncover new insights into the powerful human dynamics at play. In “How To Tell Someone That She’s Dying, “Peter Ubel shared (with permission) one of the many stories of patients unwilling to listen to their doctors’ best advice, sure that their level of medical knowledge is at least equal. These new Doctor Patients have created new frustrations and new gaps:
“Medical practice has since undergone a paradigm shift. Physicians now recognize that patients not only have a right to information but also have the right to refuse medical care. Physicians, however, are rarely taught how to partner effectively with patients in making important medical decisions that set the proper balance between helping patients make wise choices and respecting the patients’ rights to refuse medical interventions.” Read the full story, including one woman’s refusal of chemotherapy and her doctor’s struggle to change her mind.
Medical students are graduating into a climate of unparalleled complexity. The University of Michigan Medical School (UMMS) did a study of 58,294 AAMC medical school graduates. They found deep levels of discomfort with practice management, record keeping, insurance, medical economics, and managed care.
In fact, while 92% of graduates said they were confident with their clinical training, only 40% felt prepared for the managerial demands of medical practice.
In “Med Students Feel Unprepared for Health Care System,” Mike Martin quoted one of the coordinators of the study: “‘Our patients expect us to understand the system,’ said study coauthor Matthew M. Davis, M.D., associate professor of pediatrics and internal medicine at the University of Michigan Medical School (UMMS). ‘If we don’t, that can result in poor patient care’.”
It’s one thing to know what treatment would help a patient and another thing entirely to get their insurance company to agree. All the paperwork, phone calls and followup required for pre-authorizations of drugs and procedures, insurance coding, etc., costs the United States $361 billion every year — more than 2x our total spending on heart disease and 3x our spending on cancer. It’s a burden that’s not carried by doctors alone. Nurses pick up even more of the hassle.
In “Sympathy For The Doctor,” Dr. Elaine Schattner suggests the situation will get worse before it gets better:
“Now, you might think the problem can simply be fixed by hiring more assistants. Because it makes no sense for a primary care physician to spend any of her work phone-time except for speaking with patients, consulting physicians and other medically ‘substantive’ contacts. But the reality is that many hospitals are cutting back on ancillary support, such as secretaries and clerks. The lack of adequate help for practicing physicians may get worse, as big cuts loom at teaching hospitals receiving federal funds for training residents.”
Which all leads to our last clue:
Burnt Out and Over It
Almost 50% of doctors report symptoms of burnout — emotional exhaustion, low sense of accomplishment, detachment. In “Burnout and Satisfaction With Work-Life Balance Among US Physicians Relative to the General US Population,” the authors found that “Burnout is more common among physicians than among other US workers. Physicians in specialties at the front line of care access seem to be at greatest risk.”
Medicine: It’s easily among the most meaningful careers in the world. And so many aspects of it steal away that meaning and leave frustration in the void. How can we give a little of it back?
*What’s a clue? Something that Scooby Doo collected for sure. But, in this case, also the kinds of things we inadvertently collect every day as marketers: data points, personal stories, and compelling pictures. Ones that interrupt how we know the world today and point to something new. Over a period of months or years, those clues start to coalesce into bigger picture trends and shifts. Those trends let us understand people’s changing expectations so that we can create relevant innovations.