Medicine
Previous posts may have implied that restoring an adequate supply of U.S. primary care physicians is all about money - that is, less student loan debt and reducing the salary disparity between "front-line" clinicians and subspecialists. If only it were that simple! Alas, even if student loans were forgiven and salaries were doubled, it is unlikely that students would immediately flock to family medicine, pediatrics, and general internal medicine. The reason: time - or more precisely, a lack of it.
Paul Gross, MD, an academic family physician at Montefiore Medical Center in New York and editor of the online magazine Pulse: voices from the heart of medicine, recently wrote a poignant piece about the challenges of family doctoring in the context of 15-minute (or shorter) appointment slots. In "Late Again," Dr. Gross observes:
"The joy of primary care is also its curse. With each patient, I have to keep track of everything--the trivial and life-threatening, the physical and mental, the acute, the chronic and the preventive. And try as I might, I simply don't have enough time. ... My colleagues and I are often still seeing our morning patients at 1:00, when our afternoon session is supposed to begin. Lunch hour? Wouldn't it be nice. And I have it easy. One hears of offices scheduling patients every ten minutes--every ten minutes!--and doctors "seeing" fifty patients a day.
Doctors talk of running on a hamster wheel. Patients complain that their doctors seem distracted, don't take the time to listen, and run late--as I routinely do. Am I a bad doctor--disorganized and inefficient? Or maybe I'm doomed to fall short as I bump up against powerful economic forces--the 'do-more-with-less' pressures that make medical administrators everywhere create schedules like mine, designed to bring in enough money to keep health centers afloat but which end up hustling me and my patients along at an impossible pace. As a nation, we are now trying to fix our foundering healthcare system. Before we set new rules in place, shouldn't we first ask this basic question: how much time is actually required to see a patient?"
As all physicians know, time spent with patients doesn't include time spent documenting visits, reviewing test results, making referrals, filling out administrative paperwork, et cetera. A 2007 study in the Annals of Internal Medicine estimated that doctors in an academic geriatric practice who saw only 14 patients per day (most docs in private practice see 30 to 40) spent nearly 8 hours per week on these non-reimbursed tasks. This reality has led some solo family physicians to adopt a no-frills practice model that relies on few (or no) staff, leading to lower overhead costs and more time to see patients. Unfortunately, more time per patient means fewer patients per day, so such a model applied nationwide would require training even more family physicians, in addition to the ones we already don't have.
- Project C.a.r.e.s. Offers An Innovative Solution
It's rare that an article published in Business Insider "goes viral" in my Twitter and Facebook networks, but "Why Your Doctor Always Keeps You Waiting," by family physician Sanaz Majd, touched a raw nerve among friends and colleagues. In the article,...
- Advanced Access And Other Ways To See A Doctor - Stat
A few weeks ago, while at an out-of-state wedding reception, I began having chest pain that didn't immediately go away with rest and antacids. Although it was unlikely to be an early symptom of a heart attack (I'm relatively young, have good cholesterol...
- Life, Death, And Organ Transplantation - Part 1 Of 2
Several years ago, when I was a family medicine resident taking overnight call at Lancaster General Hospital in Pennsylvania, I was called to preside over my first - and so far, only - organ donation. A young woman had suffered an irreversible traumatic...
- The 50 Yard-line Perspective On Health Care
I have, without a doubt, the best brother-in-law ever, and his wife's parents are also, without a doubt, two of the best in-laws ever, as well as the owners of season tickets to the newest, biggest stadium in the National Football League. So it was...
- Why "patient Centered" Health Care Isn't The Norm
If you aren't very familiar with medicine or have had few encounters with the U.S. health system, you may think that the concept of health care being "patient centered" is so incredibly obvious that it shouldn't need to be stated. After all, we...
Medicine
Taking the Pulse of primary care medicine
Previous posts may have implied that restoring an adequate supply of U.S. primary care physicians is all about money - that is, less student loan debt and reducing the salary disparity between "front-line" clinicians and subspecialists. If only it were that simple! Alas, even if student loans were forgiven and salaries were doubled, it is unlikely that students would immediately flock to family medicine, pediatrics, and general internal medicine. The reason: time - or more precisely, a lack of it.
Paul Gross, MD, an academic family physician at Montefiore Medical Center in New York and editor of the online magazine Pulse: voices from the heart of medicine, recently wrote a poignant piece about the challenges of family doctoring in the context of 15-minute (or shorter) appointment slots. In "Late Again," Dr. Gross observes:
"The joy of primary care is also its curse. With each patient, I have to keep track of everything--the trivial and life-threatening, the physical and mental, the acute, the chronic and the preventive. And try as I might, I simply don't have enough time. ... My colleagues and I are often still seeing our morning patients at 1:00, when our afternoon session is supposed to begin. Lunch hour? Wouldn't it be nice. And I have it easy. One hears of offices scheduling patients every ten minutes--every ten minutes!--and doctors "seeing" fifty patients a day.
Doctors talk of running on a hamster wheel. Patients complain that their doctors seem distracted, don't take the time to listen, and run late--as I routinely do. Am I a bad doctor--disorganized and inefficient? Or maybe I'm doomed to fall short as I bump up against powerful economic forces--the 'do-more-with-less' pressures that make medical administrators everywhere create schedules like mine, designed to bring in enough money to keep health centers afloat but which end up hustling me and my patients along at an impossible pace. As a nation, we are now trying to fix our foundering healthcare system. Before we set new rules in place, shouldn't we first ask this basic question: how much time is actually required to see a patient?"
As all physicians know, time spent with patients doesn't include time spent documenting visits, reviewing test results, making referrals, filling out administrative paperwork, et cetera. A 2007 study in the Annals of Internal Medicine estimated that doctors in an academic geriatric practice who saw only 14 patients per day (most docs in private practice see 30 to 40) spent nearly 8 hours per week on these non-reimbursed tasks. This reality has led some solo family physicians to adopt a no-frills practice model that relies on few (or no) staff, leading to lower overhead costs and more time to see patients. Unfortunately, more time per patient means fewer patients per day, so such a model applied nationwide would require training even more family physicians, in addition to the ones we already don't have.
- Project C.a.r.e.s. Offers An Innovative Solution
It's rare that an article published in Business Insider "goes viral" in my Twitter and Facebook networks, but "Why Your Doctor Always Keeps You Waiting," by family physician Sanaz Majd, touched a raw nerve among friends and colleagues. In the article,...
- Advanced Access And Other Ways To See A Doctor - Stat
A few weeks ago, while at an out-of-state wedding reception, I began having chest pain that didn't immediately go away with rest and antacids. Although it was unlikely to be an early symptom of a heart attack (I'm relatively young, have good cholesterol...
- Life, Death, And Organ Transplantation - Part 1 Of 2
Several years ago, when I was a family medicine resident taking overnight call at Lancaster General Hospital in Pennsylvania, I was called to preside over my first - and so far, only - organ donation. A young woman had suffered an irreversible traumatic...
- The 50 Yard-line Perspective On Health Care
I have, without a doubt, the best brother-in-law ever, and his wife's parents are also, without a doubt, two of the best in-laws ever, as well as the owners of season tickets to the newest, biggest stadium in the National Football League. So it was...
- Why "patient Centered" Health Care Isn't The Norm
If you aren't very familiar with medicine or have had few encounters with the U.S. health system, you may think that the concept of health care being "patient centered" is so incredibly obvious that it shouldn't need to be stated. After all, we...