All Things EMR | Healthcare Policy & Reform | Patient Care
Canarsie, the Doctor Shortage and the Role of EHR
Last Friday, we had the opportunity to travel to the Canarsie section of Brooklyn for a visit with Dr. Bernadette Sheridan and her staff at Grace Family Practice.
It was an eye opener.
Dr. Sheridan is truly a dynamo, whizzing in and out of exam rooms while being focused and present with each patient. Her energy is in demand because she’s one of the few doctors in an area with a steady need for medical attention. Her practice is open six days a week and it’s busy every minute of those office hours. So, we talked to her about how an EHR has helped her streamline practice workflow and better track individual care.
We’re planning on more from Dr. Sheridan here in the blog and elsewhere on athenahealth.com. But in the meantime, a New York University journalism graduate student produced this excellent video on Dr. Sheridan and the current shortage of primary care physicians.
Whether it’s in Canarsie or Boise, the doctor shortage is an issue that deserves and demands attention. Our CEO, Jonathan Bush, has written about it here in the athenahealth blog. Likewise, in this recent article, athenahealth Vice President of Product Strategy, Ryan Wise, talks about the need in this environment to take “non-care work” away from doctors so they can be there for patients. Until a more reasonable ratio of primary care physicians to patients can be restored, it will be up to doctors like Bernadette Sheridan to fill the gap, but do so in a way that patients say, as one did in the NYU video, “I don’t mind waiting… I want to be examined properly.”
What’s the care situation in your area? Are there enough primary care physicians, or do the few find themselves zipping around like Dr. Sheridan?
We have about 75% subspecialist to around 25% primary care physicians in the USA. The College of Physicians put out their “white papers” back in 2006 about the crisis that general internal medicine was facing which largely fell on deaf ears. Family medicine is currently fighting for it’s life and its reimbursement in a negative sum game. I cannot speak for Internal Medicine, but family medicine practices by a different model of care unique to this great speciality of medicine and is all about treating the whole person in context of their community and family. It is built on the foundation of a personalized doctor-patient relationship and is the most comprehensive in its breadth and scope of practice and coordination of care. Some of these features are highlighted in the Patient-Centered Medical Home and are being called for in the ACO models. I do not believe the answer in this model of care is to see more and more patients but rather honor and support this great speciality of medicine to such an extent that our brightest and best medical students would choose it over other subspecialties that you end up with a majority of your practicing physicians being board certified in family medicine and general internal medicine. Remember, we have a physician shortage, about 45% in adult primary care. Because of the less than favorable work conditions and payment to primary care physicians, the USA has lost a huge number of the workhorses in outpatient medicine to early retirement or transfer out of patient care to administrative jobs. The answers are not seeing more patients (remember physicians have the highest burnout documented in a recent study out of Mayo Rochester, MN and family physicians and general internists and ER physicians on the front lines having the highest rate) but rather restoring the primary physician back to a role of the navigator of healthcare, decreasing expectations to see large numbers of patients per day, maximizing out of office communications and technology and greatly rewarding these doctors who emphasize quality and coordinate all aspects of their care and wellness and prevention.
Great post, but you forgot a major atiddional cost. The costs you quote are accurate if the rollout and purchase work without a hitch. If you implement an EMR product, only to find out that it is the wrong product or doesn’t do what it has promised, you are out at least double your initial purchase cost, probably more! I am developing a custom EMR workflow product for my client (and blogging about it on my site), and the last thing on his mind is the laughable amount of compensation from Uncle Sam.