Rebekah Bernard M.D., Immediate Past President, Collier County Medical Society
Health policy consultant Christine Bechtel may have never cried in a doctor’s office before (“My doctor made me cry. It summed up everything that’s wrong with healthcare,” USA Today),1 but I can practically guarantee that her doctor has. I know this because throughout my twenty years as a primary care physician, I have cried many times in my office, and so have most of my colleagues. I’m not talking about tears for our patients, although we do that, too. I’m referring to tears of angst, anxiety, and frustration over a broken healthcare system that has forced physicians to become assembly-line ‘providers’ and data-entry clerks rather than allowing us to truly focus on patients.
In her commentary, Bechtel references a lack of connection with her physician due to the intrusion of the electronic medical record. But as a member of the Health IT Policy Committee2 Bechtel contributed to this very situation. In fact, Medicare enacted her committee’s 2009 recommendations3 requiring physicians to use electronic health records to be paid for medical services, including specific ‘Meaningful Use’ criteria that placed unnecessary burdens on physicians. For example, beginning in 2011, doctors were required to manually enter and report data points at every office visit regardless of whether those variables had any relevance to the situation at hand. And rather than allowing staff members to enter medical orders given verbally, the committee recommended that doctors be required to enter them personally, including linking multi-digit diagnostic codes, a process that adds time and multiple ‘clicks’ to the physician’s workload. In 2016, this requirement, called ‘CPOE’—computerized physician order entry—was identified as an independent risk factor4 for physician burnout, yet in 2022, the requirements remain unchanged.
Bechtel’s Health IT Policy Committee’s recommendations also implemented a physician ‘report card.’ Doctors would now be graded and paid (or not) based on our compliance with government-created ‘quality measures.’ So, when Bechtel felt challenged by her doctor when she requested a particular medication and hurt when the doctor mentioned her elevated blood pressure, she may not have realized that her doctor was forced to take these very actions by the health IT system she advocated.
I promise you that no physician enters medicine—and certainly not primary care—with the intention of spending 7-10 minutes per patient, and then hours clicking boxes5 in a computer. In fact, when you ask physicians what they like the most about medicine, the top answer is ‘relationships with patients.’6 But stagnant reimbursement, rising costs, and unfunded mandates like those created by Bechtel’s IT Policy Committee have forced physicians to see more patients just to meet their overhead expenses.
Many physicians have reached a breaking point. Being forced to choose between providing compassionate care for patients and serving a broken healthcare system creates ‘moral injury,’ 7 leading to clinical depression in 20% of physicians,8 with 11% reporting thoughts of suicide. If Bechtel cried in her doctor’s appointment, one could imagine that her physician shed a few tears when she read Bechtel’s analysis of her care.
Established doctors are seeking ways to leave the clinical practice of medicine,9 and medical students are increasingly choosing not to enter primary care10 in favor of less burdensome specialty fields. Coincidentally, Bechtel’s experience occurred in my own hometown of Fort Myers, FL, an area that has faced a population explosion11 since the pandemic. My office phone rings off the hook every day with patients seeking a primary care physician, and area practices are so full that few are accepting new patients. The fact that Bechtel even found a primary care physician is itself somewhat miraculous.
Urging physicians to solve this problem by ‘rethinking’ workflows and ‘leveraging team members’ won’t work—and it’s a form of victim blaming. Telling doctors to ‘ask hospital or… office administrators to ease off the relentless push for efficiency’ betrays a startling lack of awareness of the power dynamic in most healthcare practices; such a request is more likely to result in the termination of the physician12 than administrators granting more time with patients. A better solution is for policy experts like Bechtel to use their political influence and personal experiences to advocate for systemic changes that decrease physician burden and incentivize a return to true physician patient relationships.
1. h t t p s : / / m o n e y. y a h o o . c o m / d o c t o r – m a d e – c r y – s u m m e d –
8. h t t p s : / / w w w. m e d s c a p e . c o m / s l i d e s h o w / 2 0 2 1 – l i f e s t y l e –