Widespread efforts to use financial incentives to encourage physician compliance with an ever-growing list of box-checking exercises are missing the forest for the trees on health care quality improvement. Qualitative research conducted by the RAND Corp., in partnership with the AMA, shows physicians derive satisfaction from spending more time with their patients and on performing the complex cognitive tasks for which doctors are so well trained.
Yet today’s practice environment is barreling headlong in the opposite direction. A time-motion study published in Annals of Internal Medicine found that for every one hour physicians spend with patients, they spend two hours on administrative and electronic health records (EHR) tasks. Then there is the much dreaded date night with the EHR, in which physicians spend their leisure time catching up on data entry.
Additional research conducted by experts at the AMA, Dartmouth-Hitchcock Medical Center and elsewhere found physicians across a range of specialties reporting a dramatic rise in these administrative tasks during the last decade.
“The biggest dissatisfaction is all the things that get in the way of taking care of patients and using your skills,” one physician told researchers. “All kinds of externally mandated requirements that … don’t translate into better patient care.”
We need to capture physicians’ time for what really matters—seeing and connecting with patients. This will require changes to a health system that is too focused on bonuses and penalties and gives short shrift to the incentive that most drives physician behavior: the impetus to deliver excellent medical care.