Is hospital medicine’s success hurting primary care?

Is hospital medicine’s success hurting primary care?

Physician career news and resources

April 2022

May 18, 2022

Is hospital medicine’s success hurting primary care?

future-health-careIt may not be breaking news, but the embrace of hospital medicine by young internists suggests that a workforce crisis is looming in outpatient medicine. Research in Annals of Internal Medicine says that while it’s well-known that hospital medicine has grown as a field, no research has formally studied career choices by internists in over a decade. A May 17 study looking at nearly 70,000 internists who became board-certified between 1990 and 2017 found that by 2018, 71% of newly board-certified internists practiced as hospitalists. That compares to 8% who practiced only in the outpatient setting. Data also show that by 2018, 40% of the internist workforce was employed as hospitalists. And from 2008 to 2018, the number of internists practicing in both inpatient and outpatient settings dropped by 56%, from 52% to 23%. Authors say that as older physicians retire, there could be a critical shortage of outpatient internists.

In closely watched case, nurse gets probation for fatal medication error

RaDonda Vaught, the former nurse from Tennessee who made a fatal drug error that killed a patient, will serve no jail time for her mistake. Fierce Healthcare reports that Vaught was sentenced last week to three years of supervised probation. Vaught admitted administering an incorrect medication that contributed to the death of a 75-year-old woman in 2017. The case was being closely watched by nurses and other health care providers who worried that her conviction would set a dangerous precedent that could hurt nursing recruitment efforts. MedPage Today reports that health care experts wondered why Vaught was being criminally prosecuted (not pursued by an administrative board) when just about everyone agreed there was no malice on her part. MedPage Today notes that the prosecutor’s motives have been questioned. He’s up for re-election this summer and may have not wanted to look weak by not prosecuting Vaught.

May 12, 2022

One in four physicians cite mistreatment at work in the last year

Nearly 25% of physicians say they’ve experience mistreatment at work within the last year. A survey of more than 1,500 physicians at Stanford published in JAMA Network Open found that patients and visitors were the most common source of mistreatment, and that women were twice as likely as men to experience mistreatment (31% vs. 15%). Other physicians were ranked as the second most common source of mistreatment. Researchers found that perceptions mistreatment was associated with a 1.13-point increase in burnout on a scale of 1 to 10. Mistreatment was also associated with a 129% increase in intent to leave a workplace. When physicians feel that there their workplace has no mechanisms in place to protect them, researchers found a 2.41-point increase in burnout and a 711% increase in intent to leave.

Can a “secret” medical expert make legal trouble for you?

Medscape article examines the frustration felt by physicians who are inappropriately named in malpractice suits by anonymous medical experts. The report says that some states allow malpractice cases to go forward based on the certification of a single anonymous medical expert. That can be frustrating for physicians inappropriately named in these cases because they can’t question the credentials of the “expert” who authorized the case to move forward. While a number of states give these anonymous experts a fair amount of power in driving malpractice lawsuits, at least one medical society is thinking of fighting back to protect its physician members.

May 4, 2022

What specialties have the highest incentive bonus?

incentive-bonuscompilation of salary by Becker’s Healthcare Review found that orthopedics has a significantly higher incentive bonus ($126,000) than any other specialty. The specialty’s average bonus is a full 26% higher than the second highest average bonus for ophthalmology ($100,000), and it’s more than four times higher than the average bonus reported by internists ($29,000). Family medicine reported an average incentive bonus of $30,000, while pediatrics reported an average of $28,000. Psychiatry reported an average incentive bonus of $33,000.

When money isn’t everything: Negotiating beyond salary

A MedPage Today article by a family medicine resident looks at other factors that physicians should consider negotiating when interviewing for jobs. When it comes to sign-on bonuses, her advice is simple: Don’t accept the first amount you’re offered, since it’s probably not the best and final amount the organization is willing to offer. Another big ask the author suggests? Automatic, annual pay increases, which can take the form of cost-of-living increases (to help offset inflation). The author also suggests asking for increases to reward staying with an organization for a certain amount of time or for hitting certain revenue targets.

April 27. 2022

Physicians unhappy with EHRs much more likely to want to quit

A new survey finds that clinicians’ dissatisfaction with their EHR is associated with those people wanting to leave their organization. In a survey of more than 59,000 clinicians, the research group KLAS found that burnout was the No. 1 factor associated with clinicians saying they were likely to leave their organization. But the survey found that dissatisfaction with an organization’s EHR was about half as powerful as burnout in pushing clinicians to the point that they felt likely to leave. Of clinicians who are specifically unhappy with EHR implementation, training and support, one-third say they are likely to leave within the next two years. HealthLeaders reports that clinicians who are very dissatisfied with their organizations’ EHR are almost three times as likely to say they plan to leave as physicians who are very satisfied with their EHR.

Physicians continue to embrace employment, even (or especially?) during the pandemic

The number of physicians employed by large organizations showed no sign of slowing down during the pandemic. In 2021, 73.9% of physicians were employed by hospitals or corporations. That number was up from 62.2% at the start of 2019, according to data from the Physicians Advocacy Institute. Those numbers mean that almost 110,000 physicians have jumped to an employed position since January 2019, with 58,000 working for hospitals and 50,000 working for other entities. The report found that the South saw a 94% increase in the acquisition of physician groups by corporations, and the Midwest continued to have the highest percentage (63.5%) of physicians employed by hospitals and health systems.

April 21, 2022

Physician pay rebounds in 2021, rising an average of 7%

Medscape’s 2022 physician compensation report says that average income for all physicians rose in 2021 by 7% to an average of $339,000. In 2020, by comparison, average physician pay came in at $299,999. Internists reported an average of $264,000, pediatricians reported $244,000, emergency medicine physicians reported $373,000, and psychiatrists reported $287,000. Just about every specialty reported a gain in pay over 2020, but less than half of physicians in many specialties say they feel like they’re fairly paid. Fierce Healthcare notes that the survey found wage gaps along gender and ethnic/racial lines that have persisted for years. Male PCPs earned 23% more than females, and male specialists earned 31% more than their female colleagues.

Should making a “Top Doc” list be important to you?

How important is it to make a “Top Doc” list? A Medscape article looks at the pros and cons of these lists, but most commenters on the article come down pretty hard against participating in them. The article, for example, says that some of the surveys rely on recommendations from other physicians to identify top-performing physicians, but many veteran physicians say they’ve never been asked to recommend a colleague for the lists. Several commenters also said they knew terrible doctors who somehow made it onto these lists. One commenter said two doctors who made these lists were actually barred by their hospitals from patient care. The article also notes that the lists may be more popular among specialists than PCPs, who often have more patients than they can handle. And one commenter noticed that in the years he made one of these lists, he received huge volumes of junk mail as a result.

April 14, 2022

Study: Physician burnout doesn’t seem to hurt performance

peer reviewA new study found that there’s no evidence that being burned out negatively affects the quality of care physicians provide. If anything, the data found, patient outcomes for burned out physicians seem to show that they provide slightly better care than their colleagues. The study in Health Affairs started with a hypothesis that physicians who report frequent burnout would also have higher Medicare costs of care, higher rates of preventable visits to the ED and 30-day readmissions. Researchers instead found that physicians who reported the highest levels of burnout had “generally lower rates of undesirable outcomes.” Healthcare Dive reports that the study looked at Medicare claims for 1,000 family physicians to see if there was any relationship between how physicians ranked themselves on seven categories of burnout and how they performed on measures that looked at ambulatory care, ED costs and readmissions. Researchers emphasized that their study does not mean that burnout is a good thing and say their findings simply suggest that “the relationship between burnout and outcomes is complex and requires further investigation.” The study did find, however, that the 2.4% of physicians who reported “daily callousness” did have worse outcomes.

Is “moral injury” a bigger problem in health care than in the military?

A study of “moral injury” finds that health care workers in the age of covid may have a higher risk of certain types of the problem than post-9/11 military combat veterans. Moral injury is generally defined as the impact of either perpetrating, failing to prevent or witnessing acts that violate a person’s moral beliefs. While burnout generally describes the effects of ongoing stress, moral injury tends to refer to damage done to a person’s identity or conscience. The study, published in the Journal of General Internal Medicine, found that 51% of health care workers reported experiencing potential moral injury from the actions of others. That number was slightly higher than the number of military vets—46%—who similarly reported potential moral injury from the actions of others. Under one-fifth of health care workers (18%) reported experiencing potential moral injury from their own actions compared to 24% of military vets. Becker’s Hospital Review says the study found that both types of moral injury were linked to symptoms of depression and worse quality of life among both veterans and health care workers.

April 6, 2022

Nonphysician providers at one ACO increased costs of care


A new analysis of an accountable care organization (ACO) in Mississippi has found that primary care provided by nonphysician providers was significantly more expensive than physician-provided care. A study of patients cared for at Hattiesburg Clinic, which employs 118 PAs and NPs, found that for a large group of Medicare patients, patients cared for by nonphysicians with independent panels under physician supervision cost an average of $43 more per member per month. The study, which was published in the Journal of the Mississippi State Medical Association, found that if all of the clinic’s patients were followed by nonphysicians, their care would end up costing an additional $10 million a year. An article on AMA’s Web site says nonphysicians spent more on care through increased testing, referrals to specialists and ED utilization. The data also showed that physicians had higher patient satisfaction scores and performed better on nine of 10 quality measures.

Nurses worry that sentence for Vanderbilt RN will have chilling effect

Since a Vanderbilt University Medical Center nurse was found guilty of homicide last month for making a fatal medication error and is facing up to eight years in prison, nursing groups have been attacking the decision as a “dangerous precedent” that will have a chilling effect on current and future generations of nurses. RaDonda Vaught has admitted that she contributed to the death of an impaired 75-year-old patient in 2017 by mistakenly giving the patient a wrong medication. Kaiser Health News reports that her conviction and looming sentence have nursing organizations crying foul. They’re predicting that it will make nurses more reluctant to report errors and near misses, which will hurt efforts to prevent future errors. Nursing organizations are also worried that the decision will hurt nursing recruitment efforts, which are already struggling to keep up with a shortage of RNs. Last week, quality improvement experts chimed in, saying that the case illustrates the need for health care organizations to reform systems that make errors all too likely. Fierce Healthcare reports that the Institute for Healthcare Improvement warned that the nurse’s conviction should be a “wake-up call” for health system leadership to protect both caregivers and patients when it comes to systemic problems in health care. The IHI says that instead of punishing individuals, health systems need to encourage the reporting of mistakes so organizations can learn from them. The IHI worries that the recent legal decision will discourage clinicians from coming forward.

March 31, 2022

EHR use, value-based purchasing raise doc time on documentation


A new study finds that physicians of all specialties who use EHRs spend an average of 1.84 hours a day outside of office hours on documentation. By comparison, physicians who don’t use EHRs spend 1.10 hours a day outside of office hours on documentation. The study, published in JAMA Internal Medicine, found that among respondents in primary care, surgery and medical specialties, 64% said they were happy with their EHR and 64.5% found documentation to be easy. Despite that, 58% said they spent an inappropriate amount of time on documentation, which reduced time with patients. The study also found that physicians who participated in value-based purchasing spent even more time outside office hours on documentation: 2.02 hours per day. Physicians who didn’t participate in value-based purchasing, by comparison, spent 1.58 hours per day outside office hours on documentation. The study also found that the use of scribes didn’t seem to affect the time physicians put into documentation.

Staff shortages (not just covid) increasing errors, hurting patient care

More than one-third of physicians in countries hit hard by the pandemic say they’ve seen an increase in medical errors because of staff shortages, and three-quarters are worried about the quality and safety of care those shortages are causing. A report from Survey Healthcare Global collected data from physicians in the U.S., France, Germany, Italy, Spain and the U.K. A Medical Economics article says the survey found that while covid is the biggest reason for staff shortages in five of those six countries, burnout was cited as the second biggest reason, with 40% of respondents noting that shortages began before the pandemic. Eighty percent of respondents said that staff shortages are creating longer wait times, 69% said shortages are decreasing the quality of care, and 72% say their patients have had their access to treatments delayed. More than half of physicians said those delays have hurt their patients’ health.

March 24, 2022

What do physicians really think of telehealth?

A new study by Optum found that while 64% of physicians are somewhat or extremely satisfied with the technology behind virtual care, most also think there’s room for significant improvement. When asked what technology they were using for televisits, 90% of physicians said they had used video, 80% said they had used the phone and 30% had used secure messaging. When asked about their frustrations with telehealth, 58% of physicians pointed to “the quality of care I can provide.” Just over half (55%) identified patients’ unrealistic expectations of what can be accomplished in virtual care, and 50% pointed to the quality of audio during televisits. Forty percent of physicians said better audio/video technology would help improve telehealth, and 35% said integrating virtual care with their EHR would help improve televisits. The survey found that primary care visits were most common, accounting for 75% of virtual care. Chronic care visits were a close second, accounting for 72% of visits, while prescription refills accounted for 64% of visits. The survey noted that while three quarters of survey respondents were PCPs, one third of respondents used virtual care to provide patients mental health support.

What young physicians want from their first job

While it’s no surprise that young physicians value work/life balance, a new survey found that it’s taken on even more importance in the last few years. A CHG Healthcare survey of physicians out of residency for two to three years found that 85% of respondents said that work/life balance was the No. 1 factor in choosing a first job. That’s significant because a 2018 survey by the same company found that 65% of respondents identified work/life balance as the top factor. Other factors highly ranked by physicians (“very” and “extremely” important) included location (83%), work schedule (83%), job/employer stability (79%) and salary (77%). The survey found that 23% of physicians started their job search before their final year of residency, 25% started during the first half of their last year of residency, and 19% started during the last half of their last year as a resident. More than two-thirds (68%) of residents said their residency program was “not highly helpful” in finding a job, and nearly 70% said they could have used help in negotiating the contract and compensation. Despite those comments, 70% of respondents said they were “somewhat” or “completely” satisfied with their first employment contract.

March 17, 2022

Will you lose patients to the new test-to-treat program?

lose-patientsThe Biden administration’s new test-to-treat program is raising concerns as it tries to direct patients who think they have covid to get a diagnosis and prescription from pharmacists instead of physicians. The Advisory Board reports that hundreds of locations, many of them the local outlets of large chains like CVS, Walgreens and Walmart, will begin participating in the program this month. On the physician side, the AMA has voiced concerns that cutting PCPs out of the loop could lead to problems when pharmacists who don’t have any in-depth knowledge of patients prescribe a new treatment. Medscape reports that on the pharmacist side, 14 pharmacy groups are unhappy that only pharmacies with on-site clinics will be able to prescribe and administer covid therapies. They want the program expanded so more pharmacies can care for covid patients. Supporters of the program praise its focus on making it easy to quickly get covid drugs, particularly given that the two available antiviral therapies need to be taken within five days of the onset of symptoms. Physicians counter that potential interactions between a drug like Paxlovid and other therapies are “not trivial,” concerns supported by a report in Annals of Internal Medicine earlier this month. That perspective piece looked at interactions between Paxlovid and common therapies for conditions other than covid.

Malpractice premiums continue to rise, but covid not necessarily to blame

For the third year in a row, physicians have seen a huge surge in malpractice premiums, but analysts say that the fallout of covid hasn’t yet made its mark on insurance rates. A new AMA report says that after remaining relatively stable from 2010-2018, about 27% of malpractice premiums increased in 2019. (That number was almost double the percent of premiums that increased in 2018.) Then in both 2020 and 2021, an even bigger number of malpractice premiums (30%) increased. The report also notes that 12 states reported large numbers of double-digit increases last year. In Illinois, for example, nearly 60% of premiums jumped 10% or more. Other states with large percentages of premiums that jumped by 10% or more included West Virginia (42%), Missouri (30%), Oregon (20%), South Carolina (17%) and Idaho (11%). AMA analysts note that premiums are rising for multiple reasons that include “deteriorating underwriting results” and “lower returns on investment.” The report notes, however, that the pandemic’s long-term effects on malpractice premiums are not yet clear. Analysts note that for now, at least, base malpractice premiums have not been affected by covid.

March 10, 2022

After a shaky 2021, telehealth showed big gains in late 2021

telemedicineThe stats are in for 2021, and after some ups and downs, telehealth finished off the year strong. A report in Healthcare Dive says that while telehealth had a rocky 2021 and hit a record low percentage of medical claims in October, it rebounded at the end of the year. Data found that telehealth claims grew more than 11% from November-December 2021, accounting for 4.9% of all medical claims. While mental health topped the list of telehealth diagnoses, covid was No. 2 in December and No. 3 in November. A Fierce Healthcare report says that another survey found the physicians it surveyed appear to be bullish on telehealth, particularly when it comes to primary care. The survey, which was conducted by the tech company Wheel, found that 63% of surveyed physicians expect virtual primary care to bypass in-person care within five years. For some, that may be good news: Two-thirds of surveyed physicians said that hybrid practice environments fit with their lifestyles better than in-person only care.

Two physicians’ thoughts on caring for—or firing—difficult patients

With incivility seeming to be at an all-time high, physicians are wondering how to deal with difficult patients.

A dermatologist writing in Medscape recalls the recent patient who was livid when he refused to give her a letter for work excusing her from getting a vaccine, something he says was neither medically indicated nor ethical. As his department’s chief of service, the physician is often called on to mediate with patients who want another opinion or to talk to someone who’s in charge, but he says the requests are getting more unreasonable. There was the patient who wrote a complaint about a physician who she thought was a foreign medical graduate (the physician was Ivy-League trained) and the patient who wanted a refund after a biopsy came back negative. But this patient was in the exam room jabbing her finger in his chest and calling him a “(expletive) terrible doctor.” The solution? He told the patient he needed to leave the room to retrieve a dermatoscope, which gave the patient time to calm down. On his return, he told the patient that she can’t verbally abuse staff at the practice. She apologized—and insisted that he should still write the note.

What about patients that won’t cool off or back down? In a piece about dismissing patients, a veteran physician says he can count on two hands the patients he has had to fire in his 40-plus years of practice, but he says that it is sometimes necessary. Writing in Physicians Practice, the urologist suggests a handful of steps to try to make the process of dismissing a patient crystal clear and painless. That includes notifying the patient in writing (certified mail with a return receipt to confirm the patient received the letter), but not necessarily giving the patient a specific reason. Explain in the letter that you’re making the move so the patient can “find another physician who can provide you with the medical attention that you require.” The physician also suggests giving a deadline for the termination (30 days) and offering to give a copy of the records directly to the patient or to the new physician who will be caring for the patient.

March 3rd, 2022

A day in the life of the ED during covid: harassment, threats and assaults

How bad has it been working in emergency medicine during the pandemic? A perspective piece published by The Guardian tells a tale of patients threatening, harassing and assaulting ED staff. The author, an emergency medicine physician, recalls one patient who was physically dragged out of his ED by security and then threatened to return with a gun. Local police said that because they had checked the man’s apartment and found no weapons, they were powerless to restrain him— and too short staffed to station someone at the hospital. While the man never returned, the physician created a plan to evacuate patients in case he did come back. As one ED nurse who had been assaulted on the job told the author, “People will walk into the ER, throw their garbage at you, and walk out. They’ll just walk up to you, say ‘F you,’ and walk out.” The Guardian article says that statistics show that in 2021, health care workers were 50% more likely than people in other industries to have been bullied, harassed or hurt as a result of covid.

Neurosurgery, orthopedics lead the gender gap for pay in academia

equal-pay New data find that the gender gap among academic subspecialists begins as soon as these physicians enter the workforce. A JAMA Network Open study found that women had lower starting salaries in 42 of 45 subspecialties and lower salaries after 10 years of practicing in 43 of 45 subspecialties. Earning differences were most pronounced in neurosurgery, orthopedic surgery and cardiology. Researchers also found that it took female academic subspecialists a year longer to be promoted from assistant to associate professor, a delay that reduced their earning potential considerably. In a Medscape article on the study, physicians said they hoped making these data public would encourage female physicians to strive for pay equality. The article cites a Medscape surveythat found male physicians earn 35% more than their female colleagues.

February 23, 2022

What do the people you work with think of their jobs?

happy-faceWhat do the people you work with think of their jobs in health care? According to a new poll commissioned by USA Today, the good news is that 80% say they are somewhat or very satisfied with their jobs, and 73% agree with the statement, “I love working in health care.” The bad news is that while 59% say they’re hopeful about their work, that number is down almost 20 points from a survey conducted last year. USA Today coverage of the survey notes that one in four respondents say they are likely to leave health care, and 52% say they are burned out. It’s no surprise that nurses are often bearing the brunt of the downsides of working in a pandemic, but a new survey by McKinsey says that 32% of RNs are considering leaving their current jobs. That’s a 10-point increase since the question was asked in February of 2021. About one-third of nurses who are thinking of leaving want to go into non-patient care roles, while about 20% plan to leave the workforce altogether to retire or for family reasons.

In 2022, expect pay raises in health care to be small and rare

One factor that may make it tough for health care organizations to hang onto employees may be money—or the lack thereof. An article in Becker’s Hospital Review reports that only one-third of health care employers in a new survey would commit to giving raises of over 3%, putting health care on the bottom of the list of 15 different industries. (Outside of health care, 44% percent of employers said they plan to raise worker pay by more than 3%.) Additionally, 43% of health care organizations responding to the survey didn’t give pay raises in 2021 and they don’t plan to in 2022. More than half of health care employers said they were going to shift compensation structures and strategies in 2022, perhaps because 87% said they faced hiring challenges last year.

February 17, 2022

For first time in years, staffing issues are biggest worry for health care CEOs

staffing-helpFor the first time in 17 years, health care execs say staffing concerns are the biggest thing keeping them up at night. A survey by the American College of Healthcare Executives found that financial concerns, which had placed top on the survey since 2014, came in second among the 1,300-plus CEOs of community hospitals who responded. While 94% of the leaders said nursing shortages were most pressing, 45% said PCP shortages were on the top of their list of personnel issues and 43% said specialist shortages were most pressing. Becker’s Hospital Review reports that when it comes to financial issues, 87% of CEOs said costs for staff and supplies were the most concerning.

Have you seen prior auth problems put a patient in the hospital?

Prior authorizations are irritating for physicians and patients alike, but a new survey of physicians says that they can also cause patients physical harm. In the survey of 1,000 physicians, 24% of respondents said they had seen prior authorization issues cause a patient to be hospitalized, and 18% saw prior authorizations lead to a “life-threatening event.” Another 8% had a patient experience a disability or sustain permanent bodily damage–or even death–as a result of interference from prior authorizations. A MedPage Today article says that the survey, which was conducted by the AMA, found that 82% of physicians said prior authorizations can “sometimes” lead patients to “abandon” recommended treatment, and 30% said prior authorization criteria are rarely or never evidence-based.

February 11, 2022

What do malpractice lawsuits look like for internists and FPs?


What do malpractice lawsuits look like for internists and family physicians? A Medscape survey of internists and family physicians found that 42% said they had been named in a malpractice suit either by themselves or with other parties. The biggest reason for the lawsuit (cited by 41% of respondents) was a failure to diagnose or a delay in diagnosis. The second most common reason (26%) was a poor outcome of progression of disease. Nearly two-thirds of respondents (63%) were “very surprised” and 28% were “somewhat surprised” by the lawsuit. Most (84%) thought the lawsuit was not warranted, and 35% said it was settled before trial. The survey found that about one-quarter of internists and  family physicians pay between $5,000 and $10,000 a year for malpractice insurance.

A patient has filed a complaint with your medical board. What do you do?

A patient has filed a complaint with your state medical board and an investigator has showed up at your office and is asking to come in so you can answer questions. Do you need to let the investigator into your office and drop what you’re doing to have a conversation? The answer is probably no, according to lawyers interviewed for a Medscape article that looks at the 10 things you should not do when you’re being investigated by your medical board. While you need to keep your cool with medical review board officials, these lawyers say that you don’t necessarily want an investigator poking around your office looking for other problems. The article suggests that physicians try to schedule an interview at a lawyer’s office, providing a safe place to meet and time to prepare. Other advice in the article focuses on how to respond to complaints thoroughly but without providing too much information, and how to handle an offer to end the case with a consent agreement.

February 2, 2022

Value-based what? Volume still rules physician pay


While there’s been a lot of talk about shifting physician pay to value-based models, new research shows that more than 80% of primary care physicians and more than 90% of specialists are still paid based on volume. The study in JAMA Health Forum found that in 31 physician organizations affiliated with health systems, those systems are still giving physicians financial incentives to maximize their volume. A HealthLeaders article says that while financial incentives focusing on quality and cost are widely used, they account for relatively little percentages of physician income. Those bonuses account for only 9% of PCP income and 5% of specialist income. In about 70% of physician organizations studied, volume-based incentives accounted for more than two-thirds of compensation.

Which docs are spending the most time in their EHRs?

Most physicians would say they spend too much time with their EHR system, but new data say that factors like gender, specialty and geography have a big effect on how much time physicians spend on after-hours charting. A study by athenahealth found that physicians at larger organizations tend to spend about 8% more time with their EHR systems, in part because those organizations often have more complex documentation requirements. Specialty also matters, with primary care physicians averaging 23.3 hours per week on EHR time (the most in the report). Orthopedic surgeons, by comparison, spent an average of 17.9 hours per week on EHR time, the lowest in the report. Researchers also found that physicians in New England spent about 30% more time on EHR duties than physicians in the Southeast region of the country. And while there weren’t major differences in total hours spent on EHRs by gender, the report found that female doctors spent more EHR time outside of patient appointment hours. The data were collected in the first half of 2021.

January 26, 2022

How would you like to get paid for replying to patient e-mails?

money-get-paidA health system in San Francisco is conducting an experiment that allows clinicians to bill for responding to patient e-mails. STAT reports that a program at UCSF has been up and running since November of last year to allow clinicians to bill payers for handling patient e-mails that take longer than a couple of minutes to respond to or that require medical evaluation. During the pandemic, Medicare allowed reimbursement for these messages, and most of the payers UCSF works with have allowed the policy as well. While it’s unclear how much payment is actually reaching clinicians, UCSF says it has seen payment of about $65 per e-mail. Most or all of that reimbursement comes from payers, not patients.

ED docs top the list of the most burned-out physicians

While the pandemic has been hard on all physicians, ED physicians top the list of burned out physicians according to a new Medscape survey. The survey found that 60% of ED physicians say they’re burned out, a steep rise from the 43% of ED docs who reported burnout in last year’s survey. Just under half of all physicians (47%) reported being burned out this year, which is a 5% jump from last year’s survey. Critical care physicians were the second most burned out group in the survey (56%), followed by ob/gyns (53%). Women also report higher levels of burnout (56%) then men (41%). The highest source of burnout was bureaucratic tasks (identified by 60% of respondents) and a lack of respect (identified by 39% of respondents). More outpatient physicians (58%) said they were burned out than hospital physicians (48%). A Healthcare Dive report says the survey also found that 20% of physicians surveyed said they were depressed, with about one-quarter of those respondents saying they were clinically depressed.

January 19, 2022

The pandemic continues to make physicians less happy outside of work


New data show that the pandemic is continuing to take a toll on physicians. A Medscape survey found that about 60% of physicians say they’re happy outside of work, a steep drop from the 80% who reported being happy outside of work before the pandemic. The survey also found that about 60% of female physicians and 53% of male physicians said they would take a pay cut to have a better work-life balance. Nearly half of female hospitalists say they’re either conflicted or very conflicted as parents by their work demand, compared to 29% of men. Healthcare Dive reports that most physicians surveyed (83%) are married or in a committed relationship, although that number is higher for men (89%) than women (75%) physicians.

What’s the biggest stressor for health care workers?

We’ve talked about how physicians are faring during the pandemic, but what about the nonphysicians who work with you? A new survey by the company Software Advice asked a wide range of health care workers—not just physicians—how they’re coping with stress during the pandemic. The top stressor is increased workloads due to turnover, which may explain why nearly half of respondents said their practice had seen between one and five people quit since the pandemic began. (Fear of getting infected with covid and discomfort from wearing PPE were the next two biggest stressors.) More than half of the workers interviewed said they had considered quitting because their jobs are so difficult, and 35% were considering leaving the industry altogether. The biggest factors that kept those people from quitting were pay and benefits, but loyalty to employers was also an important factor.

January 12, 2022

Hazard pay for health care workers: ready for prime time?

In a New York Times opinion piece, a cardiologist says that health care workers entering the third year of the pandemic who “have confronted more death and sickness than ever before in our careers” deserve one thing: more money. To offset burnout in the middle of staffing shortages in yet another surge, the author calls on federal and state governments to provide hazard pay to workers on the front lines of the pandemic. He notes that under labor law, federal workers handling “virulent biologicals” (like a virus) may already qualify for hazard pay that amounts to a 25% bonus. While the cardiologist acknowledges that hazard pay won’t necessarily cure burnout in the ranks of health care workers, he says it would at least recognize the outsize burdens those workers have faced during the pandemic. Democrats and Republicans have proposed federally funded hazard pay for health care workers, but the efforts went nowhere.

Under omicron, delays in elective surgeries are returning

Faced with a surge in omicron, hospitals and health systems are once again postponing elective surgeries. Fierce Healthcare reports that Illinois, Massachusetts and New York have recommended or implemented delays in surgeries and that health systems in about half of all states have postponed elective procedures. Orthopedics appears to be taking the biggest hit, while cardiac surgery and nonelective general surgery appear to be unaffected for now. The Web site CalMatters reports that with one-third of California hospitals facing critical staffing shortages, a number of elective surgeries have already been canceled. The state’s health department is considering postponing elective surgeries in which patients wouldn’t suffer immediate harm. The Fierce Healthcare article has a list of health systems that have shut down elective surgeries.

January 05, 2022

EHR time went down, then up, during the pandemic

If you’re like most physicians, you found yourself spending less time on electronic health records at the beginning of the pandemic. But by the summer of 2020, you likely found yourself spending more time than ever working with your EHR. That’s the conclusion of a new study in the Journal of the American Medical Informatics Association published last month. A report in Becker’s Hospital Review says that on average, clinicians spent about 80 minutes per day using EHR systems before the pandemic, but that number dropped to about 65 minutes during the early days of the pandemic. By early July 2020, however, that number had bumped back up to 86 minutes per day. The study found that the increase was due in part to increased time in clinical review and in-basket messaging. By early July of 2020, clinicians were receiving about 4% more in-basket messages than before the pandemic

Survey finds burnout, verbal abuse on the rise for nurses

A new survey finds that about 20% of nurses personally know a health care provider who has died of covid, 30%-40% are less happy working as a nurse, and one in five are burned out or very burned out. The survey, conducted by Medscape, found that 31% of nurses had experienced emotional abuse at work in the last year, with managers/administrators the most commonly cited source of abuse. About 20% of RNs and LPNs suffered physical abuse at work in the last year, the survey found, and at least 40% of nurses said they had experienced verbal abuse in the last year. Patients were the most common source of verbal abuse, with the exception of CRNAs, who said that most verbal abuse came from physicians. One-fifth of nurses said the least satisfying aspect of their job is administration/workplace politics. The most rewarding aspect was helping people and making a difference in people’s lives.

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