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Though traditional fee-for-service reimbursement is tied to volume, quality patient care can’t be increased by simply adding more appointments.
Editor’s Note: Physicians Practice features contributions from members of the medical community. The expressed opinions are that of the writers and do not necessarily reflect the opinions of Physicians Practice or its publisher.
Physicians are increasingly being squished. As reimbursement rates decrease or remain stagnant, many people think the solution is to see more patients. Unfortunately, this just doesn’t work in medicine. Those who tend to see patients as consumers seem to also be the same ones who think rushing patients in and out of the office to increase numbers is the answer.
Here are six reasons why seeing more patients is not the solution:
They need more time with physicians and other healthcare providers than ever before. Patients usually have more diseases to monitor and potential complications to watch out for. Additionally, patients are often on more medications, and physicians need more time to discuss potential side effects and interactions. Shortening visits even further means more patients leave the exam room with questions unanswered and conditions undetected. This takes more time down the road. And it sets up the stage for missed diagnoses and unnecessary complications.
When we see more patients, we have less time to document, and we are already struggling against an ever-increasing charting burden. We need to report certain metrics to meet MIPS/MACRA requirements. We can’t see more patients and record more data at the same time.
Patients often conduct their own internet research on Dr. Google before they come to see us. This does not save time in most cases. Rather, patients come in with many questions that need answers. If we address their concerns up front, they don’t need to call back with additional questions that weren’t answered at the time of their visit or return to have us look at something that was left unexamined.
Some doctors now limit the number of problems patients can discuss at one visit. I am a family doctor, and often patients may have many disparate concerns that end up being related. For example, a patient may be concerned about why she is so tired and why her legs are swelling. Those are two concerns. However, if we listen to all her concerns, she may also tell us that her hair is falling out and she has trouble swallowing. These added concerns lead me to make the diagnosis of hypothyroidism.
When patients feel we don’t spend enough time with them or listen to all their concerns, they are not happy. They come to use and are worried about a problem, stressed out about life events or just wanting to make the best decisions to stay healthy. We can do much to ease that - if we have time.
When we rush patients in and out to try to increase numbers, we are not able to comfort our patients. Again, this may lead to follow-up calls. Or worse, the patient writes negative reviews about us online or looks for another doctor who can give them 5 extra minutes, both of which can cause our profits to decrease. While we can’t make every patient happy, we should do our best to listen and try to help them find answers.
Everyone is talking about the high degree of burnout among physicians. Most of us are already operating at full steam. Trying to pile more on us is only going to make this problem worse. When we see more patients, we often are left with piles of paperwork to complete after-hours due to the endless load of increasing documentation requirements.
Doctors are human. We need rest, too. We have families, and they need us too. Unless we are allowed to take care or ourselves and our loved ones, our health will suffer. An ailing doctor is not an effective one.
While many in the C-suite think seeing more patients can boost productivity and profits, they fail to see the reality those on the frontlines face every day. Pushing more patients through a dysfunctional healthcare system is not helping anyone, patients or healthcare providers alike. Executives at organizations may see an initial boon to the bottom lines, but over time they are going to burn their resources (i.e., doctors) to the ground. Then they will be left with a crowd of patients in the waiting room and no one left to take care of them.
If we want to improve physician efficiency and productivity, we need to fix our broken healthcare system first.
Linda Girgis, MD, is a family physician in private practice in South River, N.J. She is also the author of six books, the editor-In-chief of Physician’s Weekly and a widely-published author. You can find more of her work at www.drlinda-md.com or follow her on twitter @DrLindaMD.