By ROB LAMBERTS, MD
Dr. Wes (a cardiology blogger who all should read) wrote a very compelling post about technology and the bondage it can create for doctors.:
The devaluation of doctors’ time continues unabated.
As we move into our new era of health care delivery with millions more needing physician time (and other health care provider’s time, for that matter) – we’re seeing a powerful force emerge – a subtle marketing of limitless physician availability facilitated by the advance of the electronic medical record, social media, and smart phones.
Doctors, you see, must be always present, always available, always giving
This sounds like dire words, but the degree to which it has resonated around the web among doctors is telling. He continues:
Increasingly the question becomes – if we choose future doctors on their willingness to sacrifice for others without expectation of appropriate boundaries and compensation – will we be drawing from the same pool of people as the ones who will make the best technically-skilled clinicians? What type of person will enter medicine if they know that their personal life will always take second place to patient care?
Dr. Brian V (long last name, but another one who you all should read) adds his voice to this:
It started with the pager and it’s evolved to real-time social media.
I’ve seen it too many times: Physicians excited to please open the door to unlimited patient email only to see themselves shutting their families out at night as they answer questions – all for free. And those physicians who suggest that emails should carry a fee are indicted for greed.
We have been on EMR for 14 years, yet we don’t accept email from our patients. We could do it, but we don’t – and both of these doctors hit on the head the reason why we don’t. The goal of IT in our office can be summed up in one word: efficiency. The practice of medicine has become dominated with non-clinical tasks.
- We have to gather information and organize it.
- We have to serve as an “information central” for our patients, collecting from disparate sources to make informed choices.
- We have to comply with the maze of government and insurance industry rules.
- We have to give information to patients and to other medical providers.
So what actually happens in our office is less medicine and more information management. IT allows us to do this in less time, leaving more time for our patients.
Accepting emails from patients at this point would mean more time spent doing un-reimbursed tasks. Actually, it would potentially decrease our revenue, handling problems outside of the office (for free) instead of being paid for our services. Doing so would give us three options:
- Working extra hours to make up for lost revenue.
- Giving free care via email and just accepting less pay, seeing less patients total.
- Spending less time with each patient to make up for the decreased revenue.
I am busy enough that I don’t want anyone to have to come in for things I could handle remotely. Email communication with patients sounds ideal in many ways. But unfortunately, the business case for this is so bad that we can’t open ourselves up to patient emails. One answer would be to have a minimal charge for an e-visit ($20?), which would be credited toward an office visit if the e-visit warranted that the person come in to be seen. The amount needs to be enough to ward off frivolous questions, and would have to be applicable to ALL insurances (including Medicare and Medicaid).
Email also works well with the idea of the “medical home,” which reimburses doctors for overall care of populations. (I give my opinion on the medical home in this post.)
Until this happens – until we are somehow paid for giving care outside of the office – this useful technology will remain unused. Is it greedy to not want to give things away for free? Is it greedy for me to not want to spend less time with my family, make less money, or spend less time with patients? Is it greedy to think I am worth $20?
If so, you can call me greedy.
Rob Lamberts, MD, is a primary care physician practicing somewhere in the southeastern United States. He blogs regularly at Musings of a Distractible Mind, where this post first appeared. For some strange reason, he is often stopped by strangers on the street who mistake him for former Atlanta Braves star John Smoltz and ask “Hey, are you John Smoltz?” He is not John Smoltz. He is not a former major league baseball player. He is a primary care physician.
I will do emails when i am paid for them. Period. Just like a lawyer or CPA.
My mistake for giving a damn. Just hope the people who visit this site find what they want. It won’t be enough from a computer though. When we stop getting enough satisfaction from genuine, supportive, sympathetic human contact, all will be lost.
Good luck America. you need it, you just won’t be getting it from these people in DC.
Exhausted: The only way it can be a for-profit business model is if we can post our prices up-front and compete based on quality and cost. The hidden nature of the cost of HC is what makes it so damn complicated and frustrating. It’s what makes people not trust us. Why should hospitals charge $10 for 1 pill of Tylenol? Why should there be hemorrhoid cream that costs $100?? Why don’t doctors ever tell you what they will charge for a visit? The system prevents/enables this, and makes us targets of mistrust. Add to it docs who do gouge the system by seeing 50 patients per day, and we are obvious targets of suspicion. The problem is that people are lumping us all under the same mistrust. Why go after a PCP who wants $20 for an email the same as you go after cardiologists doing stents, ophthalmologists removing cataracts, or other specialists making 4-10 times our income doing less vital work?
Joe: I don’t charge half for a 10-minte visit, but you have it backwards. If I spend 45 minutes with them, I get the same as if I spend 15 minutes (roughly), and if I spend 10-mintues or even 5, I get 75% of what I get for the highly complicated patient. The system has decided that I am better served to spend 5 minutes than I am to spend 30. I would that reimbursement was related to time spent! It’s not. That’s not my fault.
I don’t think you answered my question. Do you believe in a for profit model to drive health care, or not? And if you do, how do you really provide good care when you are simultaneously watching your wallet? Not that I think you personally do this. But, I think our colleagues have bought into this bs that we should be making a killing. Literally!
Didn’t take long for the validation, re: how the government is planning to make emailing a forced practice: “And what many believe to be an outdated reimbursement system–one that drives doctors to schedule office visits when a phone call or email might do–doesn’t help”
Ok, but based on who’s judgment? Isn’t that the doctors’, pardon the pun, call?
http://www.usatoday.com front page story today, I can only wait to read the health deform advocates’ take on this. Oh, go to page two if you read a paper (you know, that material you line your bird cage with, to wipe your windows with, oh, and get some information from when your computer crashes), “A Portland Ore practice where doctors provide more care via the phone or email than face-to-face”.
One more pearl from the article: “Greenfield Health [probably the group in Oregon as noted above, founded in Portland in 2001] doctors answer questions and resolve problems, such as interpreting test results or adjusting medications, without seeing patients.” Hmmm, I wonder how many follow calls they take after the patients did not write down all the critical facts/points from that first call?
Yes, there is probably a sizeable percentage of situations that a phone call or email would suffice, but does the government understand the greys of health care? Nope. One size fits all. And oh how tight around the collar it feels for a good many of you in these situations from government regulated matters, eh?
Enjoy the article. Health care deform does fit for me!!!
I would have no problem paying the 20 dollar fee out of pocket for being able to report symptoms and rationales and getting a test ordered before my visit thus avoiding the second visit to review the test resulting from reporting this information and saving trips and time and delay in treatment. . .it’s what a co-pay costs anyway!
Go ahead. Charge – I believe good things in lide needs to be paid for. And hire an intern to screen emails and respond accordingly.
because heal is an issue that does not follow a clock. i would prefer to write to my family doctor, who knows my history, to respond with a suggestion or referrral instead of standing in ER and being checked by an unknown doctor.
” And hire an intern to screen emails and respond accordingly.”
At a minimum it would have to be the office nurse as is done with phone calls now. The problem is it takes a well trained person to get all the history points just to make a good judgment about disposition. So, the costs remain since a staff member must get paid and then there is no revenue against that. Insurance contracts and public plans prohibit payment for anything but a face to face visit, reinforced by the arcane coding system which requires an exam component. I expect telemedicine will occur over the internet. It will just come from outside the country where the regulators can’t reach. The answer is cash only.