Doctors Face Tough Challenges in the Workplace

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Being a doctor isn’t what it used to be; crazy busy schedules, wrangling with computerized records, trying to remember what your children look like after another long week.

We asked our physicians what is the hardest problem they face in their practice.  While no one is surprised about Work/Life balance being number one at 52 percent, the fact that 21 percent of physicians name EHRs as their biggest work headache is telling.

EHR challenges led to a new niche in medicine.  A medical scribe is a person with knowledge of medical terminology who follows a physician throughout their day and enters EHR information for them.  Medical scribes are a small but growing part of medicine.

Another new challenge facing physicians is the increased demands of MOCs (maintenance of certifications).  Doctors now need continuing education credits more frequently and often the MOCs are tied to their ability to work in their specialty.  If MOCs aren’t kept up-to-date physicians can lose hospital privileges or worse.

Work Life Balance for Doctors

We asked doctors earlier this year about physician burnout and what contributed to it.  The top answers included:

  • Lack of control
  • Dysfunctional workplace
  • Extremes in work (boredom/chaos)

As a physician what is the hardest thing for you about your practice?  What would you change?  Do you agree with the poll or do you think there’s something important missing?

If you’re an M.D. or D.O. you can join our free, physician-exclusive community.  Come on in and contribute to cases, vote on polls like this one and more.

How Long Does Your Doctor Really Spend With You?

how a doctor spends his time

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by Linda M. Girgis, MD, Family Practitioner

I often hear patients complain their doctor barely spends time with them at their appointments. Many feel rushed in and out, dumped on the curb, their wallets lighter by a co-pay. But, the truth is far from assembly line medicine. Patients rarely stop to consider the time we spend outside the exam room on their behalf, and it is hours a day.

Prescriptions eat up hours

Pharmacies often call us when a patient’s insurance rejects a prescribed medication. Instead of letting our patients battle it out with their insurance companies, we do the task ourselves. We spend time trying to find equally effective alternatives that may be on their insurers formularies. If not, then we are condemned to do the dreaded prior-authorization. The whole process can take up to half an hour of just being on hold waiting to speak to a living person. Or it can mean filling out prior authorization paperwork required by a particular insurance company. The patient just sees the prescription waiting for them at the pharmacy and not the work that went into getting it into their hands.

Diagnostic testing causes headaches

Authorizations for diagnostic testing can take hours, sometimes days, occasionally months. It includes a phone call to the insurance company, or a case management company as many now use.  These calls can take 30-45 minutes of hold time to reach the responsible party.  Office notes need to be faxed over for review. Often, the decision is made for a one-on-one peer consultation before approvals are granted. This means the doctor has to have a phone discussion with the medical director of the insurance company. Usually, this is a 15-minute call but can be longer.

When I’m fighting insurance companies, I can’t be in the exam room. These days the majority of my time is stolen by people with checklists following up on the work I do.  They never see a patient or understand the nuances of a case. Doctors simply cannot examine patients and do these tasks at the same time. Every day, there are more and more regulations requiring us to do more paperwork and record more metrics.

EMRs and my former personal time

Doctors do not have the leisure to go home at the end of the day and just put our feet up and relax. Many days, I take my laptop home to work on patient charts after hours. To ensure we’re using our chart software in a meaningful way, the government dictates what information is important (even if we don’t agree).  We are often filling in data points that are useful to the government for tracking purposes, but not to our individual patients. While we may spend 15 minutes with a patient in the exam room, recording that visit often takes longer. So, while most people go home and put their jobs down for the day, many of us are spending more time with patient charts.

On Call Is Still A Way Of Life

Doctors must be available 24/7 for patient care. Many of us take call hours and are available all night for calls and emergencies. We often sleep with phones next to us in case we’re needed, regularly jolted  by a 4 am call.  While this is not time in the exam room, this is time available to our patients to provide them better care. Yes, I’ve even taken a call at 3 am on Christmas morning, my children dreaming of Santa and presents.

Patients might feel they are at war with us as they try to get more face-to-face time.  We feel we are in a war of paperwork and insurance bureaucracy to make sure our patients get the care they need.  All we ask is for patients to take a little time and think about what happens outside of the exam room.  That’s medicine too.  Maybe if we work together we can reform the system, tame the paper tigers and put us back where we belong, with our patients.

Bio

Linda Girgis, MD

credit: Linda Girgis, MD

Dr. Linda Girgis MD, FAAFP is a family physician in South River, New Jersey. She has been in private practice since 2001. She holds board certification from the American Board of Family Medicine and is affiliated with St. Peter’s University Hospital and Raritan Bay Hospital. She teaches medical students and residents from Drexel University, UMDNJ, and other institutions.  Dr. Girgis earned her medical degree from St. George’s University School of Medicine. She completed her internship and residency at Sacred Heart Hospital, through Temple University.  She has appeared in US News and on NBC Nightly News.

Doctors Support Mandatory Flu Vaccines

flu poll, flu vaccination poll

A recent Sermo Physician Poll supports medical personnel receiving flu vaccines to protect both employees and patients.

The question asked, “Do you support mandatory flu shots for medical personnel?” The results:

  • 70%  Yes
  • 30%  No

Why Flu Shots Matter

One endocrinologist who worked in a hospital commented, “The interest is not in minimizing sick days but in protecting immunocompromised or frail patients who come for care. All hospitalized patients are also offered immunization though I would assume there are no negative consequences to refusal.”

As we reported earlier, some facilities, like Johns Hopkins, require the flu shot or terminate the employee.  Another doctor noted a more novel approach for compliance.  “The flu vaccine is mandatory for all employees. If anyone refuses, they would need to wear a face mask at work for the entire flu season. Not surprisingly, we have 100% compliance.”

Population Compliance

The CDC tracks the numbers annually of the general population receiving the flu vaccine.  Last flu season was a five-year high for compliance rate.  Across the U.S., 58.9 percent of children and 42.2 percent of adults received vaccinations.  The CDC added:

Based on a study of the 2012–13 flu season, flu vaccination … prevented an estimated 6.6 million illnesses, 3.2 million medically attended illnesses, and 79,260 hospitalizations.

Compliance did vary greatly by state.  South Dakota had the highest compliance rate of 57.4 percent and Nevada had the lowest at 36.4 percent.

Some theorize the increase in vaccination could be due to the anti-vaccination movement which supports other immune-boosting strategies such as eating well and avoiding sick people.  Sermo columnist Linda Girgis, MD, family practitioner recently debunked many of the myths common in the “anti-vaxx” movement.”

A Warning for This Year’s Flu Season

Early indicators suggest the predominant strains for the 2014 – 2015 flu season will be influenza A (H3N2) and influenza B.  However, Ascel Bio Vice President and Infectious Disease Forecaster, James Wilson, M.D. said there is an issue with the nasal spray vaccine (“FluMist”) this season, it might not be as effective against H1N1 (swine flu) as in prior years:

“As forecasted, we are seeing an H3N2-dominant type A season, so concerns about whether the vaccine will protect against H1N1 infection is not looking relevant at this moment in the season.  We will of course continue to monitor the season in the coming months to see how much H1N1 activity there ultimately is.”

As a physician do you prefer using a shot or the nasal spray for your patients?

Physicians Strongly Support Childhood Vaccinations

Doctors know the threat of low vaccination rates.  We have seen diseases cropping back up that had been under control such as whooping cough in California and measles in the New York area.  Another vaccination poll, conducted in August, showed 79 percent of physicians think unvaccinated children should not be allowed to attend school.

As a physician, do you get an annual flu shot?  Do you think medical personnel should be required to vaccinate or risk losing their jobs?  Do you think wearing a mask is enough encouragement for medical personnel to receive a shot?  We will be discussing this more inside Sermo, if you’re an M.D. or D.O. please join us.

 

What the Republican Win Means for Medicine in the U.S.

election results for healthcare, election results for medicine

Last night’s “red wave” brought Republicans back in power in the Senate and pushed the House to the biggest Republican majority since 1932.   Their big win and a few state ballot questions will have a direct impact on medicine in the US. We’ve rounded up a few results.

Recreational Marijuana now legal in five states and Washington, D.C.

Recreational marijuana bills passed in Alaska, Oregon and Washington, D.C. last night but failed in Florida. They join Colorado and Washington state. Healthcare pundits are watching what impact this will have on the population and if it will change opinions about medical marijuana.

 

Medical marijuana is currently legal in 23 states and the District of Columbia. Despite the growing number of states passing laws for its use, several bills were defeated. In 2014, medical marijuana passed in 14 states but failed in seven.

Physicians aren’t a big fan of marijuana; a SermoSays poll showed that 61 percent would not prescribe marijuana to a patient, even if legal. They cited Federal laws still in place and other medications that work equally well.

Drug Testing of Doctors Fails in California

Proposition 46 failed in California last night. The bill called for an increase in malpractice settlements from $250,000 to over a million and also called for standardized drug testing of physicians.

Only 35 percent of doctors think drug testing should be mandatory for physicians. A SermoSays poll from April breaks it down by profession among hospital administrators, HCPs, and pharmacists.

Physicians cite the dire consequences for their peers if they test positive. Often a positive test means the immediate suspension of license. A family practitioner wrote, “this seems to be a completely misguided ‘solution’ to a problem that may be real, but has a lot of other, and more effective, potential solutions.”

Dismantling Obamacare?

Obamacare will likely take a few hits after this election cycle. Expected Senate Majority Leader, Mitch McConnell, said it will be a top issue for his party. While no one thinks the entire Affordable Care Act will be repealed, Republicans will focus on the following three areas:

  • Repealing the medical device tax
  • Restoring the minimum hours for workers to qualify for health insurance from 30 back to 40 hours per week
  • Eliminating the mandatory compliance for health insurance

What do you think about last night’s election results? As a physician, do you think medical marijuana has a place in the U.S. healthcare system? Would you eliminate mandatory health insurance? If you’re an M.D. or D.O. we will be discussing this in detail inside the Sermo community. Please join us.

Doctor Curmudgeon Battles Paperwork

Doctor Curmudgeon, Halloween humor

Doctor Curmudgeon has a lot “on her plate.”

Patients to see.

Forms to fill out.

Phone calls to make.

Emergencies to handle.

She tries to organize, to keep her desk neat.  She is in a losing battle. By nature, the good (and possibly messy) doctor finds her organizational skills lacking.

However, she keeps up the good fight.

Periodically, she tosses items to the shredder, to the circular file.

Seeing a clear area on her desk, she feels so good about herself.

And then, she leaves for the night.

Forgetting her mobile phone, she returns to the office and tiptoes…because it is dark and she always tiptoes in the dark.

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8 PM.

The office is locked.

The alarm is turned on.

The office manager’s desk is neat.

Tomorrow’s charts are stacked neatly.

The front desk is pretty neat.

The lab area is clean and neat.

The break room is neat.

Coffee maker is ready to be turned on by the first person arriving in the morning.

My partner’s desk is neat.

And then there is a gentle rustling.

Possibly a paper giggle or two.

A lonely paper slides out from under the office manager’s door.

It quickly glides through the half open door to my office.

It leaps upon my chair, somehow managing to dump some ink on the seat.

Then, suddenly more papers appear.

They spread over the desk in a disorderly fashion.

They come together and they multiply.

Ye Gads! Those papers are procreating!

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I will leave condoms and birth control pills scattered around my desk.

Maybe they will take the hint.

But then again, I have heard of ”The animosity of Inanimate Objects!”

What do you do with the papers?

I am despondent.

I am hopelessly enmired as the papers and paper clips grow in number, causing my desk to groan with the weight.

And in the background, a witch’s cackle becomes louder as she approaches and orders me to

Set fire to your whole desk!

Heh! Heh!

That is your only chance

It is futile to resist

Halloween approaches!

Heh!

Bio:

Diane Batshaw EismanDoctor Curmudgeon is Diane Batshaw Eisman MD, FAAFP, a Family Physician, writer, voiceover artist, and medical educator. It was in the Neolithic Era that the doctor became renowned for expertise in Trephination. After so much time in practice, Doctor Curmudgeon is now cranky and has rightfully earned the honorific of “Curmudgeon.”

Doctor Curmudgeon has no idea of what will appear in this space. It depends on the Good Doctor’s mood and whatever shamans and doctors are channeled at the moment.

As a curmudgeon, I may stray from what I observe happening in medicine and slink into other areas. But that is the prerogative of a Curmudgeon.  Please check out my first book, “No Such Agency.”