Conclusion: For every hour physicians provide direct clinical face time to patients, nearly 2 additional hours is spent on EHR and desk work within the clinic day. Outside office hours, physicians spend another 1 to 2 hours of personal time each night doing additional computer and other clerical work. (Sinsky et al, 2016)
If we only had the tools and the administrative support that just about every one of us has been asking for, there wouldn’t be a doctor shortage.
The quote here is from 7 years ago and things have gotten even worse since then.
Major league baseball players don’t handle the scoring and the statistics of their games. They just play ball.
Somehow, when the practice of medicine became a corporate and government business, more data was needed in order to measure productivity and quality (or at least compliance with guidelines). And somehow, for reasons I don’t completely understand and most definitely don’t agree with, the doctors were asked not only to continue treating our patients, but also to more than double our workload by documenting more things than we ourselves actually needed in order to care for our patients. Even though we were therefore becoming data collectors for research, public health and public policy, we were not given either the tools or the time to make this possible – at least not without shortchanging our patients or burning ourselves out.
We didn’t sign up to do all this, we signed up to care for our patients. And we were given awkward tools to work with that in many ways have made it harder to document and share with our colleagues what our clinical impressions and thinking are.
It takes a lot of years to become a doctor, and sometimes many more years to become a good one. I don’t know whose harebrained idea it was to require us to do all the data entry to serve those other purposes that were never part of practicing medicine before. It has been said that seeing two more patients per day will pay for an assistant/scribe or whatever is needed.
So… Why is this not happening? In my own personal experience, we survived 15 minute visits with a previous EMR. With our new one (Epic, the probable industry leader), that is simply not possible. What’s wrong with this picture?
With clerical support, there wouldn’t be a doctor shortage and the burnout epidemic would not have the proportions it now has.
Let the doctors do the doctoring and leave the bookkeeping to someone else, at least until the EMR technology catches up and speeds us up instead of slowing us down!
A Country Doctor Writes: 
Judy Faulkner of Epic Systems is the third wealthiest self-made female in the US, with a “net worth” of $6.8 billion in 2023. All made out of burdening physicians with extra, unpaid work
Two comments:
1) My Internal Med doc hired a scribe to be in the room with him and take notes. When Covid hit she was gone. I asked about it and he said most of her cost came out of his cash stream. Not sure of any other details on that arrangement.
2) With third parties paying the bill, as charges and payments go up, Employers want to know how their money is being spent. Given the intangible nature of medical services, the “Health” Insurance companies thus devise schemes to answer that spending question in many different ways.
Just my opinion based on 28 yrs at the two largest Health Insurance companies in my state.
Hans, like so many of your other posts you are spot on. This one though is one of your best. The doctors I know are very smart people but with a skill set that makes them excellent at taking care of people in their chosen specialty. But most are also lousy at business and without the personality needed to survive and thrive in the cold unfeeling corporate world (nor would they want to be like that). Is there a solution? Less like that there will be a solution or a resolution as there will simply be an evolution into what just grows out of circumstances like we find ourselves in.
This happens in other professions too. I’m a scientist and while my predecessors at work had the help of a librarian, a secretary, a typewriter and a scientific illustrator, I handle every step of my research. Why am I less productive than my predecessors? Have only myself to blame 🙄.
After 32 years of practice I waved the white flag and admitted defeat. I hadn’t had a vacation in 6.5 years, worked 60+ hours in the office per week, every week, 1/3 of it documentation and still left with EHR ‘tasks’ in the hundreds to be done on weekends, if I could find the energy. The flaming-hoop-data-entry we had to jump through, including ‘measure’ recording in order to receive full payment and supposedly to improve the health of our patients (nothing to support this, America is nowhere near top of the class on the global health report card, with an ongoing downward trajectory). For me, this resulted in burnout, weight gain because I couldn’t scrape up energy to run/work out as I did for years, cynicism and less reimbursement every year. My pay for 2022 was less than I earned over 20 years ago.
What a waste of time to have to check boxes and enter the date when the patient had her mammogram, for example, to prove to the insurance that you did your job. That same insurance company that PAID for said Mammogram, and should be able to pull the information from THEIR databases. Multiply that waste of time by 20 or so other measures for each patient seen that day. I guess it’s much cheaper to have me pay staff to do that, or add it to my pile of oft ignored weekend tasks. Meanwhile, the CEO of said insurance earns more in 3 weeks than I have in my entire career put together (his salary/perks close to 60M per year).
It took much soul searching to leave family medicine and a large patient panel that felt like extended family. I am not retiring; just reinventing myself in a new role with a physician owned company, using an EHR developed in-house that focuses on what is necessary, and a renewed sense of excitement for getting to work every morning. I’m old enough to recognize the bullshit, and wise enough now to step to the side of it.
Best assessment of the modern physician predicament I have ever read. Thank you for providing us with a concise explanation of this terrible tragedy that is destroying the foundation of healthcare in America.
Absolutely true. Agree.
Very unfair to force physicians to do metric documentation especially Primary care
Excellent post.
But we have to admit that physicians very much ALLOWED this to happen.
The profound lack of functionality in EMRs and their basic incompatibility with what we do as physicians was grossly obvious more than thirty years ago. Add to that primary care medical societies that we’ve allowed to completely abandon any responsibility for representing the interests of their members – and we find ourselves in this mess.
To quote a great philosopher, “We have met the enemy and he is us.”
Ugh. I should be retired but I’m working in a correctional facility and don’t even have an EMR! The tasks are as burdensome as ever. Handwritten notes and orders, handwritten consultation requests and review of labs, radiology and since NO EMR, sketchy medical records if any at all. Now I answer to the state AND the subcontractor. No relief here either…,
Very well said, but we physicians have allowed this to happen. We should never work for anyone but ourselves, develop our own meaningful EMRs, and deal only with our patients, i.e. concierge medicine.
This is one of the best topics I have come across on Doximity . Absolutely true !!
I wish all the data we enter was for research or public health, but it’s just a massive waste of time that feeds into the machine of billing for the insurance company. It’s so absurd and honestly gets in the way of good patient care
I agree with Dr. Zeller. I worked with MDVIP my last 9 years in practice. It gave me my life back, allowed me to be a better physician to all my patients, and spend as much time as needed to address their issues. All this and allowed me to continue caring for them in the hospital as well.