As a primary care physician practicing in Portland, Oregon, I’ve experienced firsthand the problems that our health care system creates for patients and doctors—especially in a traditional clinic setting.
During a three-and-a-half hour period (a half day), I’d go straight from visit to visit without checking my computer to review notes from incoming phone calls, incoming lab results or patient email messages. Although each visit was scheduled to be about 20 minutes long, they’d inevitably take longer—after seeing ten patients, I’d be running over an hour behind. Then I’d sit down at my desk to review calls, emails and lab results, as well as finish visit notes for everyone that I saw.
By the end of the day, I often felt like I’d been hit by a truck. And worse than that, I felt like I needed to apologize constantly for inadequately meeting the needs of patients.
I’m not the only physician who feels this way: In 2010, a group of doctors in Philadelphia published a study that described their work in the New England Journal of Medicine. On average, the doctors in that practice took 24 phone calls per day; wrote 17 emails a day; processed 12 prescriptions per day (not including those made during visits) and reviewed 20 lab reports, 11 imaging reports and 14 consultation reports from specialists each day. This was all in addition to a full day of patient visits.
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Unfortunately, but not surprisingly, the United States has a shortage in the primary care workforce—as well as a shortage of primary care doctors in training. At the same time, as the Affordable Care Act is implemented and more people have access to health care, demand for primary care will only increase.
Why Are Doctors So Rushed These Days?
Most doctors in the U.S. are paid on a fee-for-service basis either by insurers, Medicare or Medicaid, which means that they receive payment only for face-to-face visits. This poses a challenge for three reasons: