Contributor: Ruchin Kansal
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Source: Bigstock |
In 2016, Eric Topol wrote his book The Patient Will See You Now. Six years later, as a patient, it feels like the situation is more like: The patient will see you when? And where?
My internist’s office is now part of a local hospital system. It takes more than three months, sometimes six, to get a doctor’s appointment. The wait times in the waiting room are longer, though I have to say the waiting rooms are looking nicer. The time with the physician is shorter, and, many times, replaced by a physician assistant (PA) or a nurse practitioner (NP). Not that the PA and NP are not qualified or don’t provide quality care, but as a consumer, sometimes I feel I might not get the value for what I am paying for. Telehealth is convenient, but not always relevant, and impersonal. I wonder if I should call urgent care or stop by my local pharmacy. Every doctor’s office has a different app or portal they want me to download.
Searching for answers, I did some research. And it is disheartening. The latest data on physician well-being in the U.S. is concerning. Mainstream news is reporting that more than 60% of physicians are reporting burnout, versus 40% pre-pandemic. Self-harm thoughts have grown from 7% in 2021 to 11% in 2022. Nineteen percent of the physicians have accessed medical help for mental health challenges, versus 14% in 2021. Further, more than 40% of physicians are afraid to seek mental health help, as it could affect their credentialing and licensure. A recent study by Stanford reveals that “among U.S. workers, physicians are more likely than others to feel the effects of imposter syndrome, a phenomenon in which someone feels inadequate despite a track record of competence.”
The same can be said about nurses. The data on the looming nurse shortage is sobering, with one-third of nurses approaching retirement age. The article “United States Registered Nurse Workforce Report Card and Shortage Forecast: A Revisit” by Xiaoping Zhang, Daniel Tai, Hugh Pforsich, and Vernon W. Lin projects a shortage of 510,394 RNs by 2030. According to an article by Kathleen Gaines in nurse.org, 87% of the nurses are reporting burnout, 83% feel their mental health has suffered, and 77% feel unsupported at work.
There seems to be no recourse. My colleagues and friends are experiencing the same. Months to get a doctor’s appointment. Lost health records. Lack of communication between treating doctors. Delayed procedures, or procedures that have gone wrong. Little time and no empathy. As if we are moving through a conveyor belt. A confusing plethora of apps, from the hospital, from the dentist, from the pharmacy. This experience of low-quality care is evident in the ranking of the U.S. healthcare system. Dead last among industrialized nations, despite spending the most - $4.1 Trillion or $12,530 per person in 2020 according to CMS, and a number projected to grow to $6.2 Trillion by 2028.
I talk to my physician friends. They confirm the data. They talk about increasing pressure to generate more RVUs, and they feel it comes at the cost of providing quality care to the patient. They talk about the ever-increasing administrative burdens, new processes, new technology, labor shortages, doing more with less, and feeling like robots. Or worse, feeling as if they have been reduced to technicians rather than practicing physicians in the process and profit juggernaut our delivery systems have become. I can understand how it can translate into the quality of my care.
Despite the promise of every delivery system out there today, as I look around just in my area: “A health system focused on you,” “Care when you need it most,” “My home. My choice.” “Better Health, Easier,” “Giving People a Healthier Tomorrow,” and so on. Perhaps a case of pure sales puffery and clumsy attempts at branding.
I agree that if I had a critical illness, I would get the best care possible. IF my insurance card allows for it. When it comes to chronic illness or routine care -- prevention, self-care, and even alternative medicine sound better than a visit to the doctor’s office.
The reasons for this situation are many – as the experts say. Increasing demand as the population ages, labor shortages, increasing consolidation, high cost of innovation, digitalization, regulation, high cost of litigation, etc. As a pragmatist, I know we will not be able to disrupt the system and solve the challenges all at once. But what can we do to make the current system a little more resilient? A little more empathetic? A little more patient-focused? I see three near-term solutions:
- Invest in the current workforce. Let us take care of our current workforce now, while we solve the long-term shortages. Invest in their mental health. Help them with resilience techniques. Invest in developing and leading high-performing care teams. Remove toxic managers. Re-evaluate their work allocation. Trust their clinical judgment. Recognize them. Celebrate them. Treat them as and make them feel human. Because that will reflect in how they care for me – the patient.
- Invest in technology. The promise of digital health remains unfulfilled. Use technology to create a personalized patient experience, and not the opposite. Use technology to reduce the administrative burden on healthcare practitioners, not increase it. Technologically, we have moved from the 30-year-old databases that formed the backbone of EHR to new means of capturing data and driving insights. Use it so healthcare workers can operate at the top of their license. Upgrade your systems. Refine your processes and automate the workflows.
- Stratify the business model. Segment the delivery system and associated fees based on the delivery model and criticality of care – hospital-based, concierge, telehealth, care-at-home, urgent care, and so on. I get what I pay for in terms of experience, versus paying the same irrespective of the model of delivery. It could rebalance the workload for the healthcare workers, while providing patients with a true choice of value-based care.
Despite the challenges, I remain optimistic about the future of healthcare. Case in point: our son is pursuing pre-medical studies to become a surgeon one day. He and his other friends pursuing medical or nursing careers represent a future generation that still believes in the power of healing, and the noble work of healthcare.
I am also cognizant of my own responsibility for my health. The best outcome is where my interactions with the healthcare system are minimized. I can do that by eating healthy, exercising, being part of a community, having a support system, and taking the time to smell the roses amidst the hamster wheel work culture of our beloved nation! So can you.
Contact Ruchin at: [email protected]