Healthcare has changed dramatically since 2009, when the Health Information and Technology (HITECH) Act incentivized a national move to electronic health records (EHR). Those incentives were successful – 98 percent of hospitals now use EHRs – but for many doctors the transition hasn’t been easy.
A recent study found that for some physicians, dissatisfaction with EHRs is actually a reason to reduce clinical work hours or leave medicine completely.
Why doctors are leaving
Published in the Mayo Clinic Proceedings last November, the study surveyed nearly 7,000 US doctors across all specialities about their personal satisfaction and career plans. The research found that nearly one in five physicians intend to reduce clinical work hours in the next year. Roughly 1 in 50 plan to leave medicine all together and pursue a different career.
Three factors correlated with a doctor’s decision to leave medicine or reduce their hours: burnout, dissatisfaction with work-life integration, and dissatisfaction with EHRs.
We all know that doctors work long hours, so the connections to burnout and work-life balance aren’t surprising. But EHRs are supposed to make healthcare more efficient and effective, not worsen the national doctor shortage.
The challenge of EHRs
Of course, this isn’t the first time EHRs have been connected to physician dissatisfaction and burnout. For example, a 2016 survey found that physicians using EHRs are at higher risk of burnout and less satisfied with the amount of time they spend on clerical tasks.
Doctors typically identify time-consuming data entry as the source of their frustrations with EHRs. As Dr. Robert Wachter, professor and chair of the department of medicine at the UC San Francisco, told an audience at the 2017 American Conference on Physician Health, “EHRs contribute to burnout by turning physicians into unhappy data-entry clerks, and also by enabling 24-hour patient access without any system to provide compensation or coverage.”
Digital medicine does require some workflow changes that many doctors, near the end their careers, may never incorporate. While the recent study found doctors of all ages and specialties report challenges with EHRs, it’s no surprise that those aged 50-59 were most likely to report their intention to stop practicing medicine.
“Physicians must often choose between communicating with the patient and navigating within the records to enter or view relevant data. That can fragment care during a patient visit.”
But others note that digitizing medical records isn’t inherently bad for doctors, young or old. The problem may be about how EHRs are designed.
According to Dr. Kevin Gebke, a family and sports medicine practitioner at Indiana University Health, “EHRs were not designed by practicing clinicians and are not intuitive regarding the different processes that take place during a patient encounter. Physicians must often choose between communicating with the patient and navigating within the records to enter or view relevant data. That can fragment care during a patient visit.”
Why EHRs need to work for doctors
As the recent study points out, now is not a great time to have more physicians leaving medicine. Not only is the US dealing with a doctor shortage – projections show a short-fall of 45,000 to 90,000 physicians by 2020 – hiring doctors is also expensive.
One recent analysis suggests that replacing a physician can cost institutions $800,000 or more. Turnover is also disruptive to patients, staff and organizational culture. A physician workforce that has one eye on the door may not be optimally engaged and aligned with advancing the institution’s goals.
The good news is that when employers know what makes doctors leave, they can implement plans to improve physician retention. As the study concludes, “Concerted efforts are needed to address these issues at the national and organizational level to preserve the adequacy of the physician workforce.”
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