JAMA Article re: What is "Driving Doctors Crazy"

"....There's so much oversight for what we do, so many people we have to answer to and so little of it improves care, it's just driving us all crazy."   Robert Perlmuter, Chicago Internal Medicine Doctor, in an article in my local newspaper today, which is reporting on an analysis in the latest JAMA (Journal of the American Medical Association) of the trend of decreasing hours physicians work, which correlated with a 25% reducation in pay for doctors' services when adjusted for inflation.  When they looked at the reimbursement rates of different cities, those with low reimbursement were the ones with the lower number of hours, those with higher had higher.  

Western Colorado was in a huge energy boom when I moved here six years ago, and many new people could not get a physician to take them, and that was healthy people that aren't 'time vampires' like those of us with complex medical needs (prescription refills are revenue vampires, for instance).  I am aware of the discussions among physicians of how many chose to go into speciality fields instead of primary care and family medicine as the reimbursements are the only way they can pay off their education, which literally ends up being the equivalent of house payment every month.   

I really enjoyed the article, written by AP Medical Writer Carla Johnson, breaking down a technical article into something streamlined which I could read in the amount of time it took for my lunch to be served.   American doctors have steadily cut the number of hours they work over the past decade, from an average of 55 in 1996 to 51 in 2008.  While some of this was due to new laws limiting the hours residents work, even with that factored out, there was still a six percent decline and it was across the board -- all ages, both sexes, residents and nonresidents.  "and it didn't occur in other occupations" said lead author Douglass Staigler, an economics professor at Darmouth College.  "Something has been discouraging physicians from working the long hours they used to work," he said. 

I personally have felt like health care has something going on where it's like rats leaving a sinking ship.  Ten years ago when I lived in Denver I had several different physicians in a short period of time because they were leaving to other areas due to the low reimbursement in the area due to the number and type of HMOs, I was told.  My health was affected by this at a critical time in my then-fragile management of fibromyaglia at the time because it takes a doctor and patient a while to develop their doctor-patient relationship, trust, and understanding.  An OTR friend of mine has said that new patient paperwork was 18 pages at the skilled nursing facility she was working on call at which lead to her saying 'I'm DONE WORKING for good this time.' She actually enjoys working and is very experienced and a valuable employee to skilled nursing facilities because she has rare hand therapy expertise.  And it's not that the pay is 'bad', it's a significant amount of money per hour for such jobs.  But it is not worth it anymore for many people.  I personally am SO concerned about what I see as a mounting crisis happening for many people in the United States and overall world and am dedicated to Lumigrate providing solutions through valid, progressive, streamlined and FUN education and resources, that I've maintained my 100% focus on Lumigrate in this startup year in order to have it be reaching potential consumers for their benefit sooner than later.

The article states that a primary care doctor now sees on average 2,300 patients, which seems to me to be an incredibly cumbersome number if there is a quality relationship where the provider can have the ability to really 'be knowing' the patient beyond what is written in a chart from the last visit.  One of the solutions suggested is to reimburse physicians for their time talking with other doctors and coordinating care, all of which are currently 'unbillable'.  Anyone who has read about the presentation I did in Berkeley in July 2009 (see blogs for that timeframe) will know that it focused on diffusing the anger by chronic pain patients at their physicians and I feel I understand the situation in a unique way because I have not only walked in the shoes as a patient with chronic pain but as a stressed medical provider mired in insurance paperwork and I can see that the solutions are to do the things suggested in this article, which will take years to change, or to immediately make change by suggesting that patients start taking as much responsibility for their health care and information as they possibly can and show the providers that they are trying to do their utmost to make THEIR job easier and to have the best outcome.   After all, these people went to medical school to treat patients for their wellness and health and not to be buried in hassles and see their dwindling reimbursement. 

I hope this has helped readers understand what they might not realize about aspects of their health care system and start them thinking and being more active in the "occupation of their health care".  I encourage you to leave Comments, below so that there can be a discussion and use YOUR expertise as a medical consumer to be part of the education of others. 

If anyone is interested in reading the actual article in JAMA the newspaper story was about, the link to JAMA is: jama.ama-assn.org