In addition to the severe shortage of doctors America will face over the next decade, a recent article in the New England Journal of Medicine entitled “What’s Keeping Us So Busy in Primary Care? A Snapshot from One Practice,” highlighted how many doctors are already too busy—and that’s before you factor in 31 million more people.
The article, which was written by Dr. Richard Baron, “documents the mundane, every-day activities of five primary care physicians in Philadelphia.” The study assessed the volume and types of electronic medical documents of the practice, Greenhouse Internists, in 2008. In addition, the doctors also participated in a pilot Patient Centered Medical Home project.
The published details cover a typical workday starting around 7AM. The results of the study found that on average, each doctor:
– Sees 18 patients;
– Fields at least 23 phone calls;
– Handles 17 emails;
– Reads 11 imaging reports;
– Examines 20 lab panels;
– Fields 14 consult notes per day; and
– Provides 12 prescription refills
All of this work is in addition writing new orders for patients seen in the office. The study also did not include paperwork that the physicians routinely complete, like physical exam records for work or camp because they were not standard electronic documents. This means that doctors probably were even busier than what is listed above. In fact, Dr. Baron reported in his average day, he feels like running from when he gets into the office and when he takes work home.
The study also found that a physician typically works between 50 and 60 hours per week, and completes many tasks that go uncompensated. The study did not mention the time doctors set aside for reading journals, continuing medical education or attending conferences.
Form these findings, it is clear that primary care physicians need more support and payment for the work they do, especially if Congress expects to do anything about the anticipated physician shortage.
One of the ways primary care can be supported, according to Dr. Elaine Schattner, is by giving doctors more time to take in new developments and consider those in the context of the patients they see. According to Dr. Schattner, physicians’ work requires continual learning and thinking, and doctors need time to:
1. Keep up with the literature;
2. Attend conferences; and
3. Consider cases in detail
She calls for these changes because “the practice of medicine is changing rapidly, so much so that some physicians are having a hard time keeping up with the technology, in itself, of providing care – electronic health records, processing of digital images and the like.” The reason it is crucial that doctors are given this time to “catch up” is because “science and medical knowledge are advancing, too, and progress in each field bears on the quality and costs of current practice.”
In other words, if primary care physicians continue their busy schedules as cited above, they are not going to have the time (not that they do right now) to learn about new drugs and treatments to offer to their patients. For example, “in primary care, physicians need to know what’s happening in preventive health, diabetes management, cancer screening, hypertension, vaccine recommendations and more.”
“In psychiatry, new drugs come with new toxicities for physicians to keep in mind, besides new science. In surgery there’s been constant development of instruments and techniques, some of which help by reducing post-op deaths, infections and durations of hospital stays.” And some new devices don’t work out so well, and surgeons need to be aware of the new findings.
As a result, Dr. Schattner correctly pointed out that “how doctors are educated matters, and this includes continuing education after they graduate from medical school.” CME programs and meetings, “provide an opportunity for doctors to exchange ideas and gain insight on new findings.” Additionally, national conferences allow physicians to “challenge new data and learn about the limits of studies by listening carefully to their colleagues’ questions and hearing experts’ responses.”
Accordingly, since industry funds approximately 50% of CME, and the government provides very little support, it will most likely be up to companies to provide the resources and programs to ensure that primary care physicians and doctors are receiving adequate CME.
If our health care reform is going to help America and patients in anyway, it most focus on giving patients more time to continuously learn about ways they can treat their patients, not by overloading their schedule even more than NEJM’s study showed. Having CME that keeps doctors “abreast of new developments and the facility with which they can evaluate information as it becomes available are critical to modern, efficient and good-quality care.”