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Doctors Make Lousy Secretaries! How Clerical Work is Ruining Our Profession

02_28_17_how-clerical-work-is-ruining-the-profession-1

drkeithfernandez

Keith Fernandez, MD
Senior Physician Executive, Privia Health

In the early days of my career, one of my favorite pastimes was catching up with my partners during the short intervals between seeing patients. My coworkers and I would commiserate about work-life balance, patients with difficult diagnostic problems, and new and important treatments for the diseases we saw in patients. But, about 10 years ago, those intervals disappeared. My partners and I were forced to fill that time typing. And, while typing was a pain, pointing and clicking were even worse. How many clicks could a doctor click if a doctor could click clicks!

I had no time anymore for telling the story of the patient, the most important thing physicians do; no time for representing a good physical in the chart; no time for giving a thorough presentation of my thought-process about how I come to a differential diagnosis, treatment, and follow-up plan. No, now I was a typist… and pointer… and a clicker. And a very expensive one at that.

I was more than a little bored, and a lot less focused because of that boredom.

How, you may be wondering, does boredom and the stress of having to do something so contrary to the skill of physicians contribute to burnout? Here’s an analogy: imagine the jumbo jet pilot loading the baggage (it’s good exercise), cleaning the toilets (it’s necessary) and spraying the plane with de-icer (I hope they are quick back to the cockpit, before it wears off) and maybe even serving the coffee to passengers during a thunderstorm! Who needs a flight attendant?!

Seriously ¥– How does the average physician ever have enough time to actually be a physician? Every year we’re expected to expend more time and energy to do more clerical work in addition to haggling with payers, understanding denials, dealing with regulatory change, and untangling the many “quality” measures, which are largely unrelated to clinical outcomes. And by the way, they tell us, your cost is only marginally “yours,” but now will determine how much you get paid with the new value-based model of MACRA.

This misplaced burden on physicians is killing the profession. It contributes to burnout, decreased physician and patient satisfaction and poor outcomes because the attention of the physician is diverted by nonclinical pursuits.

Which is why I’m glad I joined Privia. We’re a physician-led medical group that removes the administrative burdens from the shoulders of independent doctors. Through Privia’s innovative use of technology, our medical group’s physicians can focus their efforts on improving quality, outcomes, and deliver a better, more personal patient experience. Privia builds and enables high-performance physician groups and clinically integrated provider networks to help leading doctors better manage the health of our populations. Sometimes, we even have a little time left to commiserate with colleagues.

We became physicians to help patients, to have a personal relationship with them, to touch and examine them and build a confidence that we are working together to heal or prevent illness. Not to occasionally peek over the screen at our patients as we furiously type to fill gaps on a chart. That’s not to say that clerical work isn’t important – it is, and it has to be done – doctors should just shouldn’t be the ones doing it.

It is time for all doctors to come together, organize in medical groups that use the advanced technology that is now available to us, and make good use of well-trained virtual or in-office clinical assistants. Only then will we be able to take our honorable profession in a new direction, that truly puts patients and people at the center of the health system, the way it ought to be.

Discussion

One thought on “Doctors Make Lousy Secretaries! How Clerical Work is Ruining Our Profession

  1. Well said and I would add that nurses are in a very similar state of frustration and burnout.

    Posted by Denise Shope | March 1, 2017, 1:41 pm

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