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In part 2 of our roundtable, three doctors vent about EHRs and extol the virtues of having a balanced work and home life.
Can young doctors tolerate EHRs more than their older counterparts?
Part two of the first ever Physicians Practice Young Doctors' Roundtable looks to answer this question and much more. Part one touched upon why the three doctors went the independent practice route, if medical school debt weighed on their minds, and biases they've faced as young physicians.
We dug even deeper for part two, looking into if physicians who grew up in the age of computers can better tolerate current EHR offerings. We also found how much they value work-life balance and why young docs should consider using a lawyer to negotiate contracts. Below are excerpts from our conversation.
Our three doctors are:
Elizabeth Seymour, MD, 34, family medicine, Denton, Texas
Landon Roussel, MD, 32, direct primary care internist, Luther, La.
Brandi Ring, MD, 35, obstetrician/gynecologist, Denver, Co.
As a younger generation, you grew up on computers. What do you think of EHRs?
Elizabeth Seymour: Generally we understand, we've been exposed. In residency, they still had paper. We went through the EHR transition while I was there. For the first six months I was in clinic, we were all writing. I hated it. My hand got tired. I didn't leave until 6:30 at night….I didn't like it and didn't want to do that for the rest of my life. Then they implemented the EHR and I thought it was the best thing since sliced bread. In the last 11 years, being in and out of residency, I've dealt with older physicians, specialists, who don't use the EHR. It's frustrating. I can't read their notes. I don't know what's going on. That's shifted my referrals. If I can't read your note, I'm not going to waste my time trying to figure out if something is a “T” or a “J.”
I like the EHR, but I will say there is a lot more clicks, more documentation. It kind of becomes brainless, where it's click this/check that. Sometimes that takes away from your thought process of looking at your patients and connecting with them and remembering things about them. Personally I'll think, I didn't use my brain [because of the EHR] and I have to think further outside my box. What could a symptom be besides something common? I don't think the EHR helps with that.
Landon Roussel: In terms of adapting to the EHR, it's never been a problem. I grew up in the computer age and took a programming class in junior high. I found for my direct primary care (DPC) practice, when I started doing DPC and documented for my own sake, and maybe medical and legal reasons, the way we were charting in residency included a lot of unhelpful things. It didn't reflect what was going on with the patient and what needs to be done. What's enlightening is having a prolonged relationship with the patient, to where you use the EHR as an assistance. You can't remember details that you can't possibly hold in memory. But [in DPC] it's not the end all, be all of the doctor-patient relationship. It's a part of our ongoing primary-care relationship.
When I document for Medicare purposes, you see how much excess is being imposed on providers for the sake of data mining. It's getting in the way of the doctor-patient relationship and requiring us to do more work without the sake of being a benefit to the doctor, patient or the system as a whole.
Brandi Ring: They are awful. I hate them. That's the reality. They don't take better care of patients, which is what we all said we were going to do. Paper records take better care of patients, but they're harder to bill from and track data from. That's why larger corporations like EHRs better. The government got into this, now there is a payment incentive or disincentive. So we're not using them for the right reasons. We're not using them because they make patient care better because that's not what they're designed for. They don't make docs' lives better. They make them more time consuming with paperwork. They really interfere with the doctor-patient relationship.
How important is work-life balance to you? Do you think it's different for the older generation of docs?
BR: Work-life balance is super important for everyone, but the definition of work and life is what has changed. It used to be for older docs, their life was their work. One of their defining features was [being] a practicing physician. The home piece of that was less important. Younger docs are not identifying that way as much anymore. When we talk life balance, we're talking about home life and family. It's a change of definition of what people are thinking.
ES: That's extremely important to me. I'm a mom. I've got two rowdy boys- a 12-year-old and an 8-year-old. I've got to keep them busy…That's my value. I'm a doctor, but first a mom and a wife to my husband. I love my patients and value their time and our relationships, but again – if I have to stay an hour and a half in the evening charting to fulfill the Medicare requirements…it becomes cumbersome. It definitely takes away from my [home] time….I get off work at 5 p.m. every day. I don't work on weekends. I go to my kids’ activities.
There's a way to have a good relationship and be there for your family or whatever you want to spend your time on. But you can be overwhelmed. That's why I left my group setting. I was working as many hours as I was in residency. And yes, I was making a lot more, but I barely got to see my children. I wasn't sleeping and I was moody and irritable. It wasn't a life I want to live.
LR: That really resonates. I couldn't agree more.
ES: I thought it can't be worse than this. So I went out on my own. People I told me I crazy crying and that I was like a lone wolf out there. Being independent is viewed as crazy and how can you do it on your own. You can. I'm doing it as a busy mom with two young boys.
LR: I can relate to [Dr. Seymour] saying she was part of a medical group and working the same amount as residency. It was no different from residency, if not more work. We would have to be in the hospital by 6 a.m. That was our contract. I'm like, "Who signed this contract?" There is no reason to be there at 6 a.m. It's not like patients are getting worse at 6 a.m. They want to have 40-50 doctors on site at all times. When you're working 12-14 hour days for seven days on end. You can't maintain any sanity when you still have family to take care of. So I definitely sympathize with that experience working as an employed physician.
Do you use the internet, social media, etc., to market yourself as a physician? How so?
LR: We've tried a number of things and we're narrowing it down to what works. We have a local company that's very good…and they do digital marketing [for us]. We paid them to [design] our website. We paid them to do an SEO campaign that's done pretty well. That's worked out well.
We do Facebook a lot, but that doesn't bring in patients, so much as keep our brand awareness. Even sponsored Facebook ads; we haven't found them helpful for bringing patients in. For the elderly patients, it's been mostly word of mouth. Almost no elderly patients find us on the computer.
ES: I live in a university town, there are two universities and one junior college. We take care of a lot of young millennials and college-aged students. We use ZocDoc...which puts us online. When people Google that they need a family care doctor or a primary-care physician, [ZocDoc] pops up. They then put in their zip code and it will say, "Hey Dr. Seymour is in this area."
The other thing we have to be cognizant of us is patient ratings. If you're getting bad patient ratings, it's unlikely that a 21-year-old will make an appointment with you. It keeps us accountable and makes sure we're being nice and respectful. Of course there are people who are unreasonable and it is what it is.
The other thing I struggle with is telemedicine. These [young patients] want access and want it now. We're competing with urgent cares, standalone ERs, etc.. I try to promote the fact that I could save [a patient] $500 for just a visit if you didn't go to that standing ER. They're charging you hospital prices…Trying to get that across to millennials, I don't think they understand or are cognizant of it…The thing with telemedicine companies is I do Skype and telemedicine visits often and the insurance companies routinely don't pay for it. I've got [student patients] all over the U.S. and I call them and I charge their insurance and I don't get paid. So I'm sending the patient a bill, some are happy to pay, but others are not. They think it's a covered service.
What advice would you have to med school students and docs in residency not sure what to do about their career?
BR: What I tell med students and residents who are wondering about the next step [is]…they need to see what it's like. They need to take a couple of post call days and shadow in private practice. Residency is good at showing us employed practice. We've seen a hospital-based employed practice. Most of the time we haven't seen the other options. We don't know what they are – we hear either the really good or really bad stuff...Take a couple of days, go shadow a private practice doc and see what it looks like. Sit down, find a mentor who is a few years ahead of you and ask them what they did well and what didn't go so well.
ES: Be open to private practice. I understand the fear of going out of on your own. That's why I went to a group setting. But consider going into a practice with one or two other providers. Looking back, a reason why I chose to do a group right of residency was I wanted some oversight. I was still right out of residency, I didn't feel like a full-fledged doctor. I felt like the older physicians were my mentors; the people I would look up to and would help guide me. What I quickly found out - and I'm not being arrogant -is that I was prepared to do what I needed to do. There were a few things I had to keep learning about. I'm 34. I'm still learning.
Residents need to be very precautious of working with hospitals. I've seen so many go through it and get stuck in a contract. They're going to be near wherever they do residency, they probably have kids in school. They're settled and it's hard to pick up and say, "Let's move." There are non-compete clauses. There are all sorts of things that make it physically difficult to get out of a contract when you sign with a hospital. Even though it offers so much financial security, I don't know if I'd be willing to sign my life away.
LR: Dr. Seymour mentioned looking closely the contracts you sign. I was fortunate to not have so coercive of a contract that I wasn't able to get out in a good state. I was able to amicably separate from the hospital. I remember at… our residency program for hospitalists, they had a lawyer offering a deal to young physicians in residency offering to read their initial employment contract. He said he'd read it for $800. I remember thinking I don't have $800, I'm getting paid hardly enough to pay my bills. In retrospect, I should have paid an attorney to look over the contract and help me, so I could have understood the implications of it. You need to. This is your life. If you don't negotiate, it's a dog-eat-dog world in many places and you'll get taken advantage.