You Love Patients, Hate EHRs

Giving patients high-quality care is the most satisfying thing about being a physician, according to a RAND Corporation study sponsored by the American Medical Association. The study, "Factors Affecting Physician Professional Satisfaction and Their Implications for Patient Care, Health Systems, and Health Policy," identifies electronic health records (EHRs) as a prime source of stress and dissatisfaction.

Researchers based their findings on information gathered from 30 physician practices across the country, including a family medicine practice in Pflugerville. The practices included a wide assortment of medical specialties and organizational models. AMA sponsored the study to identify factors influencing physicians' professional satisfaction. 

The researchers said that while physicians acknowledge some advantages of EHRs, they complain they are cumbersome to operate and are an important contributor to their dissatisfaction. "Many things affect physician professional satisfaction, but a common theme is that physicians describe feeling stressed and unhappy when they see barriers preventing them from providing quality care," said Mark Friedberg, MD, the study's lead author.  

Key findings of the study include physicians' concern that current EHR technology interferes with face-to-face discussions with patients, requires them to spend too much time performing clerical work, and degrades the accuracy of medical records by encouraging template-generated notes. They also worry that the technology costs more than expected and that different types of EHRs cannot "talk" to each other, preventing the sharing of critical patient medical information when it is needed.

Other findings from the study include:  

  • Excessive productivity quotas and limitations on the time spent with each patient are major sources of physician dissatisfaction. The cumulative pressures associated with workload were described as a "treadmill" and as being "relentless," sentiments especially common among primary care physicians.
  • Physicians describe the cumulative burden of rules and regulations as overwhelming, draining time and resources from patient care.
  • Perceptions of collegiality, fairness, and respect are key factors affecting whether physicians are satisfied. Within the practices studied, frequent meetings with other doctors and other health professionals fostered greater collegiality and satisfaction.   

Researchers say that physicians report being more satisfied when their practices give them more autonomy in structuring clinical activities, as well as more control over the pace and content of patient care. Doctors in physician-owned practices or partnerships are more likely to be satisfied than are those in practices owned by hospitals or corporations. 

The study's recommendations are:  

  • Physician practices need a knowledge base and resources for internal improvement. 
  • As physician practices affiliate with large hospitals and health systems, paying attention to professional satisfaction may improve patient care and health system sustainability. 
  • When implementing new and different payment methodologies, the predictability and perceived fairness of physician incomes will affect professional satisfaction. 
  • Better EHR usability should be an industrywide priority and a precondition for EHR certification. 
  • Reducing the cumulative burden of rules and regulations may improve professional satisfaction and enhance physicians' ability to focus on patient care.  

Researchers did not identify health care reforms as having prominent effects on physician satisfaction, either positive or negative. Most physicians and practice administrators are uncertain about how the Affordable Care Act will affect physician satisfaction and practice finances. It was clear, they said, that a common response to health care reform is for physician practices to seek economic security by growing in size or affiliating with hospitals or larger delivery systems.   

Action, Oct. 15, 2013