Physicians feel they are failing patients or resentful of them. Many feel as if they are working like cogs in a wheel. Survey and study findings shed light on what is causing many of these sentiments. On average, physicians today spend about a third of their time with patients looking at a computer screen and about nine hours per week on administrative tasks, such as billing and insurance approval processes. A study from Johns Hopkins Medicine in Baltimore found first-year residents in internal medicine spent just eight minutes interacting with each patient. Numerous surveys have found only half of physicians would choose medicine as a career if they had to do it all over again.
Demoralization is scary thing, largely because it is messy and emotional — a problem not easily solved by healthcare policy or hospital administration. How can we focus less on sentimentality for the golden days of medicine — the pleasant collective memory of “Marcus Welby, MD” — and focus more on what we can actually fix? (For instance, Johns Hopkins Hospital turned all of its EMRs in exam rooms to face patients, increasing the opportunity for eye contact and interaction.) Many things are at play when a physician feels demoralized, such as her sense of occupational prestige and collegiality, and many things are also at stake, such as patient safety. It will be interesting to see if the healthcare system can alleviate such a deep-dwelling emotional problem with operational changes.
3. Healthcare access. The amount of time patients must wait for care is a big blemish on our healthcare system. It’s embarrassing, frustrating, and in some instances, disturbing.
The problem is especially acute in America’s safety-net hospitals. If you haven’t seen it yet, check out the documentary “Code Black,” which is set inside the emergency room of the public Los Angeles County Hospital. In the film, patients wait up to 18 hours to receive treatment because they have nowhere else to go. This wait-time problem was not alleviated by the healthcare reform law’s insurance reform. Even though more people may have health insurance coverage today, it’s not always premium, says Ryan McGarry, MD, director of the film. “And we’re already in a system where a lot of specialists won’t take a sub-premium insurance card, because you’re not seen as profitable enough,” he told NPR. “So many people end up coming to public hospital emergency departments, just to see an orthopedist, or an endocrinologist or someone who won’t take their probably decent insurance, but it’s not good enough.”
Beyond safety-net hospitals, the American healthcare system lags far behind its international peers for how quickly and conveniently it interacts with patients. Last year, the Commonwealth Fund found the U.S. came in dead-last out of the 11 Western democracies surveyed for after-hours primary care: Only 35 percent of adults’ primary care physician practices have arrangements for patients to see physicians or nurses after hours. (In the Netherlands and the United Kingdom, this figure is 95 percent.) The U.S. came in third-to-last when it came to physicians’ response time to patients who call with a question — 73 percent of U.S. adults said they “always or often hear back on the same day,” while 90 percent said the same in Germany.
For some patients, a wait time is a secondary concern. They can’t even get an appointment. The number of physicians who opted out of Medicare in 2012 was still a small proportion — about 9,540 compared to the 685,000 participating — but it was nearly three-times as many from three years prior. Even fewer physicians reported they were taking new Medicaid patients.
The moral implications of the country’s access problem are evident, especially when there is a relationship between patient access and profitability. It is disturbing to see the intentions of healthcare reform — greater insurance coverage and improved access to care — get loopholed for financial reasons, reinforcing so much ugly cynicism about the healthcare industry.
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