As Americans, we would like to believe that our health care system places a special emphasis on patient care, and to a certain extent, it does. Our physicians measure patient outcomes using metrics like hospital stay length, therapeutic efficiency and professionalism, but as the health care system evolves, it may be losing its compassion.
Although physicians remain committed to compassionate care, all too often, that is compassion for an entire roster of patients rather than an individual. More doctors are working managed care environments where the bottom line is about seeing as many patients as possible. As more hospitals and clinics adopt a business model rather than a patient care model, patient-doctor interactions become more about symptom management instead of humane care.
Why Medicine Is More of a Business Now
Almost all of the education and training that a physician receives is in how to treat a patient, but most newly minted doctors soon realize that health care is a business. Unfortunately, few physicians want to run a business; most want to help the people who come to them for aid. This inevitably leads to two possible outcomes: either work as a physician employee in a health care enterprise or hire a business manager to oversee organizational operations.
In either case, doctors are relinquishing some or all control of how they interact with patients. In a business environment, patient volume is a key to profitability for the organization, so pressure is applied to physicians to see as many patients as possible. Unfortunately, this means less time for personal interaction and often dehumanizes patients.
On the other side, if physicians want to operate more independently, they must often make compromises about patient care. Unlike the well-resourced corporations that can hire personnel to fulfill critical functions like billing, cybersecurity or regulatory compliance, independent clinics must somehow fulfill these obligations independently. This means contracting out these jobs or stretching a limited budget even further.
This financial pressure on physicians forces many to increase their workload or only see patients who can afford inflated prices. This plays out in many bargains with insurers; many clinics will enter into an agreement that allows them to see more of an insurer’s policyholders in return for a lower price per visit. Either way, patients lose out.
The rigors of succeeding in an increasingly cutthroat business environment are why so many physicians are abandoning their practices. In 2012, almost 48.5 percent of physicians had independent practices, but in 2016, this number had fallen to 33 percent.
The number one factor that doctors cite when quitting their practice is the huge regulatory burdens that require inordinate amounts of paperwork. This includes compliance with new requirements that medical records are converted into standard electronic health records. EHRs have not improved patient care with only 11 percent of physicians saying they improved interactions. Another 60 percent say they detriment patient care and add, on average, 48 minutes to each work day.
The Suffering Medical Profession
It is no secret that there is a growing shortage of doctors in the U.S. The Association of American Medical Colleges estimates that there will be a shortage of 43,000 to 121,000 doctors in the United States by 2030. This growing gap will have profound effects on health care in the coming years.
First of all, a shrinking physician population will increase the burden on physicians who remain in practice. It is estimated that 52 percent of currently practicing doctors experience some level of burnout and patient disengagement. Unfortunately, this will increase the rate of burnout in a profession that is already over-taxed.
This level of physical and emotional exhaustion profoundly detriments the American health care system. Almost two out of five doctors are depressed, and every day, a doctor commits suicide in the U.S. This level of professional dissatisfaction is also why so many doctors are leaving the profession or retiring early.
In the end, the ultimate loser in this situation is the patient. Doctors who are too despondent or tired to care are unlikely to provide the high level of care that many patients require. With so many leaving the profession, only the most desperate will remain to treat the sick. Fewer top quality candidates will make the enormous time and financial investment to join a profession that is slowly disintegrating; this will leave patients with less qualified care providers, a recipe for disaster.
Like all systemic issues, there is no simple solution to the problem of a dehumanizing health care system. Instead, we as a society should implement incremental solutions that will slowly mold this industry into one that truly values the needs of the patient once again.
Of course, this process starts in medical school. While there is always a place for medical education that emphasizes scientific information, we should also encourage our academic institutions to prioritize patient engagement. Let our students know that their time with patients may be limited, so give them the tools to enrich every interaction.
In the workplace, we need to establish more systems that not only allow patient engagement but also support medical staff. In too many hospitals or managed care groups, doctors are expected to be self-sufficient. While that may be the ideal, the reality is that physicians are just as fragile as patients—perhaps, more so.
Finally, we need to fix our health care system at the policy level. While some regulation is necessary, we need doctors to heal people not fill out paperwork. We desperately need new policies that allow doctors to partner with patients in their journey of healing, rather dictate orders. Current laws like ACA or HIPAA may strive to improve the health care system, but they don’t value the doctor-patient relationship. It may not be measurable, but this critical dynamic may play a key role in improving outcomes for future patients.
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