Neither fear the problem – nor trust the solution – too
much.
-Paul Ramsey
The
headline was clear: the United States is headed for a worsening physician shortage. The Wisconsin Hospital Association and the Association of American Medical Colleges both confirm that Wisconsin and the United States have a shortage of doctors and they predict a deepening hole, particularly in primary care specialties. The solution is not at all obvious; although medical schools can increase class sizes (and UW-Madison has recently done just that), much of the bottleneck is at the level of Medicare-funded residency training positions. The realities of the federal deficit and the looming Medicare crisis make additional funding for training slots very unlikely. Things look bleak.
As I was mulling over this predicament, I heard a
story on National Public Radio describing a self-sustaining mission hospital at the southern tip of India devoted to eye diseases and to sight restoration. The reporter interviewed an ophthalmologist about the logistics of her operating room. All day long, the staff readies the next patient for her while she is performing surgery. As soon as one operation is finished (each taking about 10 minutes), she turns her chair, adjusts the microscope, and proceeds with the next. She continues moving back and forth, one after the other, completing as many as 40 cases each day. Each ophthalmologist at the hospital performs as many as 2,000 cataract surgeries yearly. By comparison, a busy U.S. ophthalmologist performs 125 cataract operations each year. The report did not discuss it, but I assume that the Indian doctor does not stay up all night completing her dictations, filling out insurance forms, and electronically signing her charts.
I am frequently amazed by the amount of time my U.S. colleagues and I spend on tasks that drag us away from providing direct patient care. For example, in response to fraudulent Medicare claims, every home-care form and prescription now requires, by law, a physician’s handwritten signature and date. The threat of billing audits obliges me to include long, irrelevant, never-read passages and specific wordings in already cluttered medical record progress notes. In the name of privacy, electronic records time-out every few minutes and I spend many hours each year simply waiting for double-password-protected medical records and images to pop up on computer screens. In the name of patient safety, hospital charting requires every signature to be accompanied by both a handwritten date and time.
Each little delay, log-in, new requirement, interruption, signature, authorization phone call, form, and re-typed password consumes just a few seconds, but, of course, these moments add up. When combined with all of the moments spent by physicians and health care workers across the country each day, the amount of time consumed is not trivial.
Having recently glimpsed inside several hospitals in East Africa, I believe that the overwhelmed doctors there would love to have "shortages" like ours. There are, of course, no simple solutions to the challenges facing the African health care systems, but consider: There is one physician for every 360 Americans. By contrast,
Kenya has one physician for every 7,600 people, and Tanzania has only one physician for every 24,000 people.
Disturbing, too, is the
news that
"[a]bout one-fourth of the primary care physicians now practicing [in the United States] are graduates of foreign medical schools." Our shortage in primary care is siphoning off the best and brightest from some of the countries that can least afford to see their young doctors depart.
So, can an eye hospital in India that routinely screens 2,000 patients each day tell us a thing or two about efficiency? Is it possible that the East African non-physician Assistant Medical Officers can share some insights into how to take better care of our expanding population of elderly with chronic, stable conditions? What can we do to help the developing countries improve their health care outcomes without plundering their talent?
The problems — First World vs. Third World — are very, very different. At the very least, we should be able to discern better ways to help them cope with their overwhelming needs. We, on the other hand, must find ways to better utilize people who now spend their days typing notes, signing forms, constantly logging back into computerized record systems, and waiting for the opportunity to get back to seeing patients.
Share on Facebook
| |
The following is feedback received for this blog:
Hi Bruce - I can appreciate your frustration and hate to see medical professionals hindered from providing all the hands on medical care they trained to do and prefer ...versus handling the sea of paperwork, etc., they are continually inundated with. And speaking from the patient perspective ...I think it is both sad and frustrating that the patient-physician relationship is compromised due to time constraints because of regulations, insurance requirements, technology, etc.
I miss being able to chat with my former pcp. He had to close his practice last March (still in prime) because of expensive overhead and low insurance reimbursements. :(
It would be interesting to hear how these other countries are able to see/treat so many patients. And would be great if all countries could incorporate the best ideas from other countries into their health care systems/practices.
- SeaSpray |