Marginalizing the medical profession could undermine the quality of patient care
Imagine a health care system without doctors. Fortunately, this will not happen – despite all the hype about robots and artificial intelligence replacing doctors in the future.
Yet, there are many recent trends showing that physicians are being sidelined and losing influence. There are also surveys demonstrating declining morale among physicians and growing burnout rates.
These trends are quite alarming as they could undermine the quality of patient care in the future.
Root causes of perceived decline in quality of care
A new APCO Insight survey shows that a large majority of US health care providers believe that the quality of interactions with patients has gotten worse over the last five years.
What are the root causes of this?
- Loss of clinical autonomy: The APCO Insight survey reveals that a majority of physicians (74%) believe that their level of clinical autonomy, or the freedom of physicians to pursue treatment plans without interference, has gotten worse.
- New business models: The survey also showed that the perception among most physicians of new business models in health care related to the shift towards value-based care is very negative, including the rise in accountable care organizations, the use of patient satisfaction surveys to determine physician bonuses, the consolidation of smaller hospitals and provider groups into large health systems, “bundled payments”, and the shift of doctors from private practitioners to salaried employees.
- Excessive administrative tasks: The rising burden of clerical and administrative tasks imposed on physicians and their staff also have a negative impact as they divert time from clinically important activities, such as providing actual care for patients and improving quality of treatment. A survey by the American Medical Association found that an average of 16.4 hours of physician and staff time each week is spent on completing prior-authorization request for patients to get the medicines, services and procedures they need. Studies by Mayo Clinic have demonstrated a direct correlation between the significant clerical workload relating to electronic health records and high physician burnout rates.
Medicine is a business, but…
Health care is the biggest industry in the US, and medicine is a business that needs to be managed efficiently as resources and funding are not unlimited. And many of the current trends, such as the evolution of digital technology and the shift from fee-for-service to fee-for-value with the goal of achieving better outcomes for patients while also controlling costs, are here to stay.
However, declining morale among physicians and the marginalization of the medical profession suggest we may be getting close to a breaking point in health care that could sacrifice the quality of patient care.
The days are long gone when the doctor was the most powerful decision-maker in the health care system. Policy-makers, payers and administrators are now making the key decisions. Yet, it is important to remember why most people decide to make a career as a doctor: they have a deep interest in medicine but also a passion for serving patients. This element of a personal calling tends gets lost in an over regulated health care system where value and outcomes tend to become synonymous with efficiency and cost reduction.
All stakeholders need to work together to ensure the quality and efficient delivery of health care.
But the time has come where we need to rethink the wisdom of turning physicians into paper pushers and mercenaries.
Bring physicians back to the forefront of health care
There is an urgent need to engage and empower physicians and other health care providers to bring the joy back to practicing medicine:
- Enable physicians to buy-in and co-own value-based care business models making sure that they stay motivated and incentivized to spend more quality time with patients, not less.
- Free up time for physicians to have more face-to-face time with their patients, instead of spending time on clerical work. The American College of Physicians has developed a framework, “Patients Before Paperwork”, to help stakeholders eliminate, reduce and streamline administrative tasks to reduce the burden of clerical work and free up time for clinically meaningful activities.
- Simplify and tie quality measures more directly to outcomes that matter to patients, rather than transactional performance measures. As an example, reporting LDL-cholesterol levels and hemoglobin A1C is not as important for patients with diabetes as preventing vision loss, amputations, stroke and heart attack.
- Reconsider the wisdom of moving physicians from private practice to salaried employee status. Studies have indicated that savings and quality improvement are generated more often by independent primary-care doctors than by large hospital-centric health systems. And, in the United Kingdom and Scandinavia, all primary care physicians and practicing specialists in out-patient care are independent practitioners conducting their business based on contracts with the health care and payer systems. The independent status of primary care doctors has given doctors a freedom to practice medicine that allows them to stay motivated – even within a single payer health care model.
It is time to reverse these trends towards marginalizing physicians. Policy-makers, regulators, payers and health system leaders and professional medical organizations need to work together rethink how they engage physicians and bring them back to the frontline of health care.