Dr. Bhupendra Khatri heard a lot from doctors around the country in compiling his latest book, Healthcare 911: How America’s broken healthcare system is driving doctors to despair depriving patients of care and destroying our reputation in the world. But the statistic that jumped out at him came from research at the Mayo Clinic, which found that more than 55 percent of physicians in this country suffer from burnout, and every year, more than 400 physicians kill themselves.
"I've spoken to hundreds of physicians," Khatri says, "and I hear the same story - that they're not happy. They're not happy because their practices are being increasingly taken over by hospitals and larger corporations which put profits before patients."
Khatri's book highlights several key factors that significantly contribute to the high rate of physician burnout in the country:
The rise of administration. Khatri cites data that shows that in the last three decades, the number of active physicians has grown less than one percent a year, while there has been a 3,000 percent increase in healthcare administrators over that time. While some believed health care administrators would rein in spiraling costs, the influx of administrators has not achieved the expected result. In fact, Khatri points to a New York Times study which he says concludes that “the big bucks are made by people who administer health care rather than those who deliver health care.”
The changing nature of physicians’ work. The dramatic increase in administrative positions has also changed the nature of physicians’ duties. The hours have largely remained the same, Khatri says, but they are increasingly unrelated to patient care, shifting to more administrative work.
“For every one hour that a physician spends face to face with a patient, we have two hours of administrative work to do… Physicians have been reduced to data entry, and that’s not right, because we have limited time with our patient, and we are there to help them.”
Electronic health records. Electronic health records (EHR) were intended to improve access to important health information and improve standardization in healthcare. Indeed, Khatri says, “When electronic health records became mandatory… we thought this was going to help us.” However, Khatri contends, “It has turned out to be a major problem.” The result, he says, is that electronic records actually interfere with the physician-patient relationship.
New regulatory guidelines. New regulations - some federal, some from health care corporations - are dictating how many patients physicians must see in an hour and require additional documentation. With the influx of about 25 million newly insured people through the Affordable Care Act, some felt that individual practices would not be able to keep up; as such, regulations favored larger corporations and hospitals at the expense of smaller practices, causing some practices to shut down, according to Khatri.
The eroding autonomy of physicians. Khatri says the past two decades have seen dramatic changes to health care. “Whereas before the physicians used to be in control," he says, "now it’s the health care administrators who run the show.” Increasingly, according to Khatri, insurance companies dictate how and what physicians can prescribe. “They tell the physician what to prescribe, when to prescribe, how to prescribe.” If insurance companies refuse a particular treatment, physicians must resort to peer-to-peer consultations. However, Khatri insists, many times these peers do not have required qualifications to act as peers to medical specialists.
Solutions. Khatri's book does offer some solutions, both short-term and long-term, to ameliorate these trends in the profession, and offers antidotes to burnout. He points to some systemic changes he'd like to see. “Electronic health records should be able to talk to each other. If a patient goes to one clinic or another hospital, I should have access.”
Khatri identifies scribes, working hand-in-hand with physicians, as another potential relief for one area of significant stress. Currently, he says, ‘We ask the administrators to give us a scribe, and they say it’s not in the budget.”
Lastly, Khatri believes that the focus of health care must return to smaller, individual practices rather than large hospitals and corporations. Khatri says, “Individual doctors know the patients best as opposed to larger corporations, and also, it is much more economical for individual practices to take care of patients.”