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What Stops Doctors From Practicing At The 'Top Of Their License'

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Physicians may be wasting time with tasks that could be done by others with less training on their teams. That's the finding of recent research from Dubuque, Iowa internist Dr. Christine Sinsky who works with Medical Associates Clinic and Health Plans. She referred to the problem as doctors not working at the “top of their license.”

“After college, doctors spend at least another seven years in medical school, residency, and sometimes a fellowship. They learn skills that few others know, like how to do procedures, recognize the symptoms of rare diseases, and make life-changing decisions quickly. But for hours every day, many doctors handle chores that don’t require these high level skills. They are filling out one paper form after another; they are clicking boxes on yet another electronic medical record,” says Sound Medicine’s host Barbara Lewis.

Interview highlights

Q. What new duties have doctors picked up?

A. I am concerned that we are spending much of our time doing things that aren’t of highest value to our patients. Over the last ten years, there’s been an increased number of additional tasks that have been pushed to the physician. Work that might have been previously done by other people on the team—the receptionist, a medical records clerk, or a pharmacist—has been pushed to the physician. In large part, as a consequence of implementation of electronic health record.

Q.  So tell us a little bit about the study you did. You went to look to see what physicians were spending their time on. You found some alarming statistics of how much time they aren’t spending with us.

A. We did this wonderful study called "In Search of Joy in Practice" and we visited 23 high functioning practices around the country. The best of the best, if you will. Even in those places, we observed that around 70-80 percent of the physician work output was work that either could be re-engineered out of the practice, or was that low value, or that was waste, or could have been done by someone else with different technology or different policies.

Q. We thought electronic medical records would make our health care better by really informing all the doctors we see. It sounds like it’s making physicians have some headaches, but is it still better for the patient?

A. Technology has been such a win, that we assumed it would be a win in all arenas. I think it will eventually be a big win in health care, but we’re going through this time of transition and it’s probably going to be a 10-20 year transition, which I think is unexpected…So it’s not been all bad, or all good.