older doctor w: book & computer (123RF)

Through Dec. 15, federal regulators will accept public comments on the next set of rules that will shape the future of medicine in the transition to a super information highway for Electronic Health Records (EHRs). For health providers, this is a time to speak out. One idea: Why not suggest options to give leniency to older doctors struggling with the shift to technology late in their careers?

By the government’s own estimate, in a report on A 10-Year Vision to Achieve an Interoperable Health IT Infrastructure, a fully functioning EHR system, for the cross-sharing of health records among providers, will take until 2024 to materialize. The technology is simply a long way off.

Meanwhile, doctors are reporting data while the infrastructure for sharing it doesn’t exist. Now, for the first time, physicians will be reporting to the federal government on progress toward uniform objectives for the meaningful use of electronic health records.  Those who meet requirements will be eligible for incentive payments from Medicare and Medicaid, while those who don’t may face penalties. In addition, audits are expected to begin in 2016.

 

The need to keep our older doctors in the workforce

Amid this shift to a new, data-driven healthcare system, the nation needs older doctors to keep practicing to meet present needs of an aging population, as well as an expanded Medicaid system. If burdensome reporting rules encourage retirements, as some studies indicate, the building of an information highway may result in the unintended consequence of a bottlenecked road to seeing a physician. The likely result: Nurse practitioners will deliver a greater share of the nation’s healthcare.

Some critics say the medical profession exaggerates a coming shortage of physicians. Yet concierge medical practices are growing in number, luring those willing to pay a premium to see a doctor quickly for extended-time visits.

Last year, the New York Times reported on long wait times for doctor appointments as a new norm, and not just in traditionally under-served rural areas. The article pointed to one study that found patients waiting an average of 66 days for a physical examination in Boston, and 32 days for a cardiologist appointment in Washington.

Think of what the wait times would be if mass retirements materialized, as suggested by findings of a 2014 survey of 20,000 physicians by The Physicians Foundation. Thirty-nine percent indicated plans to accelerate retirement due to changes in the healthcare system. Others reported plans to cut back on patient caseload or seek different jobs.

The potential for disruption is even more startling when you consider the number of older doctors in practice. According to R. Jan Gurley, a physician writing on the blog of the University of Southern California’s Center for Health Journalism, one in three doctors is over 50, and one in four is over 60—despite roughly 20,000 newly medical school graduates a year.

 

It’s time to speak out

Because of what’s at stake—potentially the very underpinnings of our nation’s healthcare system—health providers should speak out forcefully during the government’s open comment period. Yes, it is late in the rulemaking game for EHRs. But new rules are being written for 2018 and beyond, and modifications are being made to rules in effect through 2017.

Would an outpouring of thoughtful, well-documented recommendations make a difference?  In a democracy, the answer should be yes. The value of keeping older doctors in practice far outweighs the benefit of driving them crazy as they try to meet reporting requirements with often-clumsy EHR technology. The challenge is to find a middle ground.


This article first appeared in the Akron Beacon Journal on Nov. 22, 2015. It is published here with permission of the author.

5 COMMENTS

  1. As an older physician, I need my EHR more than ever. But the MU requirements are just silly. So I got the MU bonus early on, and will now cheerfully accept the penalties and keep practicing.

  2. Computerized Physician Order Entry (CPOE) and electronic prescribing have been demonstrated to reduce medical errors, but other than these two items and the fact that computer information and data storage and retrieval is superior to paper storage and retrieval, there are many impediments to providing quality health care at reasonable costs due to the intrusion of governmental and organizational requirements such as “meaningful use” added to the already busy schedule of health care providers. The workflow challenges to meet meaningful use requirements have added to physician and nursing workload, providing no perceived benefit to patient care.

    There is essentially no data which demonstrate that the vast majority of meaningful use measures (excluding clinical decision support, electronic prescribing, and computerized provider order entry) improve the quality of patient care or reduce the cost of patient care. (Ann Intern Med. 2014; 160:48-54)

    Chief HIT geek, John Halamka, M.D., has concluded “meaningful use will not improve healthcare outcomes” and has called for “the replacement of the meaningful use program with alternative payment models and merit-based incentive payments.”

    While no one would argue that “wellness” and preventative measures, so much a part of “meaningful use,” are beneficial to a society of people, having highly trained medical people such as doctors and nurses, and even physician assistants, and nurse practitioners performing computer clicks and doing data entry instead of performing patient care, is a total waste of valuable time and resources. Someone with a 2 – 4 year college education could be well trained as a medical scribe and accomplish all the wellness and preventative measures that are known to be beneficial. Wellness is fairly simple compared to disease and pathology. There are only a few things humans need to do to be healthy and well; 1. Eat right, 2. Stay active and fit to prevent falls, 3. Don’t smoke, 4. Don’t use illicit drugs or overdo alcohol and caffeine, 5. Wear seatbelts and helmets, and 6. Get necessary immunizations. Let the doctors, nurses, and midlevel people concentrate on disease, pathology, surgery, and complex diagnostic challenges. This makes economic sense as our society grows in numbers and the proportionate number of highly trained healthcare providers shrinks.

  3. I’m definitely an “older doctor” but have had an EMR/EHR for 10 years, admit my own patients to hospital, have facility with the hospital’s impossible CPOM system, etc.
    The lack of computer & typing skills cuts across all age groups, & has little to do w/ medical expertise.
    The real issue is the onerous, unnecessary burden of meaningless (mislabeled “Meaningful”), demeaning ‘incentives’, and data collection mandated to ALL hapless, helpless physicians just trying to take care of INDIVIDUAL patients in significant, soundly medical, patient-doctor relationships. NOT Populations! That’s making US do the work of the Public Health researchers (good work indeed, but not OUR work), & providing faulty data at that, since any one practice’s results are skewed by the demands of the regulations, not vetted by anyone, & unlikely to be reliable in the aggregate. We physicians have almost no chance of reclaiming our own profession — because of unwarranted, unhealthy interference by government (CMS and Congress) and commerce (insurance companies & pharmacies). THAT is why doctors are retiring, & some of us — retiring from life itself, unfortunately. It’s a sad, sorry story. PG, MD 12/1/15

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