Navigating Change

Navigating ChangeSafe medical practice is much more than following guidelines and treating patients.  These days, it’s an all-encompassing milieu of factors far beyond medical management.  From overcoming electronic health records, understaffed hospitals and outpatient centers, declining reimbursement, burned out co-workers, angry patients who are no longer covered to see their doctors, and satisfaction measurements that we are somehow responsible for, “practicing” medicine is more of a learning to tolerate factors out of our control.In fact, as physicians, practicing actual medicine (and the thought process of diagnosis and treatment) probably accounts for 5 to 10 percent of our total time at work.  Anyone who has ever fielded a complaint from a patient about how long they waited and how briefly they were seen can attest to this.  The majority of our time is spent charting, interpreting results we may not have ordered, charting those results, getting authorizations for coverage, and clicking through innumerable boxes on an electronic record that we never really ever fully read, our patients can’t understand, and our staff – if at an education level permitting broad thinking – may barely correctly document.  A recent study suggests that up to 40% of the information entered into electronic health records is incorrect.  This is concerning in that the primary goal of these computer systems is to collect data for “meaningful use,” a government incentive program to provide increased payments to healthcare providers and networks.  This has been phased out now, but the legacy of poor data entry lives on.  Incorrect histories and diagnoses (due to the cumbersome requirements of ICD-10) are causing greater difficulty in simply deciphering the true background of our patients.  As humans, we are accustomed to following the path of least resistance.  As doctors, we are trained to leave no stone unturned. How can it be that despite being highly educated and hardened through a residency process that dehumanizes our very souls that we have come to this?
Insurance companies, with their endless access to computer systems and the garbage that has been entered into their patient records, wield this information as a trigger for denial, reducing any meaningful reimbursement from our meaningful use and replacing time spent at the bedside with time on the phone begging for authorizations and overturning bureaucratic decisions.  Like the character from Oliver Twist, hand outstretched begging “Please sir, may I have more?” we are shifting from a proactive care environment to a reactive process where diagnosing and ordering care have become a prelude to endless tasks that require implementation.  If you are familiar with the movie Animal House, it’s more like saying “Thank you sir, may I have another.”  The irony of this entire broken system is that it is intended to lead to a proactive model of improved outpatient management that avoids expensive inpatient stays in favor of improved outpatient management. Indeed, hospitals are closing their doors and urgent care and other related outpatient centers are popping up everywhere.
We have reached our mental and emotional capacity as humans.  We are not trained to perform business-oriented tasks.  We are educated and trained to identify and treat disease as altruistic humans.  To date, there is no change in site for our nationwide standardized medical school curriculum, which is still focused on basic science, didactic education, and hands-on clinical management over a four year period.  Even in residency, we are not exposed to the full degree of reimbursement, charting, time management, and balance that modern attending physicians must master.  Even the modern attendings are unable to master it! We are throwing billions of dollars into the education of additional providers and practitioners who will only propagate this lunacy.  Even our own physician advocacy organization – the almighty American Medical Association – is tweeting questions about how we can incorporate mastering the EHR into medical school education. Our own specialty organizations have missed the boat, and their focus has shifted from allowing us to be doctors, to towing the line of the corporate political agenda that lines their pockets through maintenance of certification and board recertification.  Instead, our organizations should be lobbying to let us practice safely without barriers or conflicts of interest – as professionals – and put our patients first.  They should be solving the reimbursement and core measurement issue with clinically sound solutions and alternatives rather than complacency and political pandering. In short, they should do their job to advocate for us!
Then, there’s the piece de resistance of the insanity – despite all of these barriers to doing what we are trained to do, we can be sued by anyone, at any time, and have little to no legal protection from the government that mandates we see everyone (especially in the case of Emergency Medicine and Obstetrics which are under federal statute to see everyone), and frequently denies us even the basic right to have a jury of our peers.  Instead, we dodge landmines, hope not to get the certified letter of suit, and when we do, quickly move to settlement to feed the machine.  No wonder burnout, depression, and suicide rates are increasing, while medical school admissions are on the decline. Who would actually want to do our job? Notice I didn’t say be a doctor – but do our job…
The only people we as physicians have to rely upon to fix this process are each other.  Even some of our own have placed corporate loyalty and greed over our primary focus – our patients.  Sadly, they will learn that it can be lonely at the top and they are just as easily replaced as a bad stock and a click on the sell button.  When venture capitalists and investors take hold of the wheel in the manner that they have, we have taken our seat in the back.  Change starts with us, as leaders, pillars of our communities, political donors, role models, and problem-solvers to say the one thing we are trained not to say – No.  Sometimes less is more for our patients and with healthcare, we have made it that way. A good surgeon will know when to operate. An excellent surgeon will put down the scalpel when there are better alternatives. It’s time to take back our profession. It’s time to make our profession what is should be – our patients deserve this.

Author:

Dr. Beatty received his Bachelor’s of Science in Biological Sciences from Clemson University and earned his Doctorate in Medicine from the University of South Carolina School of Medicine. He completed his residency training in Emergency Medicine at the Johns Hopkins Hospital in Baltimore, Maryland. Dr. Beatty has extensive experience as a clinician, medical leader, department chairman, medical director, regional medical director, and Chief Medical Officer. In addition to his clinical and administrative roles, Dr. Beatty has spoken at several national conferences and is an active expert medical witness. He is an avid teacher, and regularly supervises Physician Assistants, Nurse Practitioners, and fellow physicians. He has served as a physician mentor to his medical staff, and as a member of hospital credentialing, medical executive and peer review committees. Having extensively recruited, interviewed, hired, and reviewed countless numbers of healthcare providers, his expertise in team building, recruitment, and the hiring process helps to deliver the message of our programs in a way that other courses can’t match. In addition, having established an Advanced Practice Provider residency program in multiple hospitals, Dr. Beatty understands the key concepts needed to prepare Nurse Practitioners and Physicians Assistants for their transition to independent clinical practice.