Physicians say distractions interfering with delivery of quality care

A new survey of U.S. physicians reveals concern among the respondent base about the future of the healthcare industry, with two-thirds anticipating a decline in healthcare quality over the next five years. In particular, most surveyed physicians think EHRs and the Affordable Care Act (ACA) will adversely affect the quality of care delivered to patients.

The Physician Sentiment Index (PSI), conducted by Watertown, Mass.-based athenahealth and Cambridge, Mass.-based Sermo, collected responses from 500 physicians who represented a diverse range of specialties and practice sizes.

The data suggests the leading distractions affecting physicians' ability to provide the optimum care for patients center on government intervention, increased utilization of and frustration with EHRs, and administrative burdens. All told, these distractions have diminished physicians' optimism around their ability to deliver quality care and remain viable, profitable practices.

"There is a lot of stuff going on in healthcare that is making the noble pursuit of the MD degree a lot less attractive," said Jonathan Bush, athenahealth CEO and chairman. "Government involvement, ill-designed EHRs and administrative complexities are encroaching on the sacred relationship between the physician and the patient and the ability for that doctor to be fully present at the point of care."

"U.S. healthcare is changing rapidly, but time and again policymakers aren't listening to the physician perspective," said Jon Michaeli, VP of membership for Sermo. "As a result, physicians feel disempowered to influence change, and hence they are more disenchanted with their profession and less connected to patients than ever.”

More specifics of the survey’s findings are listed below.

Doctors skeptical of regulation

  • Over half (in 2012 and 2011) said that government involvement in regulation will not yield lower costs and better outcomes, with slightly more pessimism on display this year.
  • A growing number are concerned about the ACA’s impact on the quality of care. Nearly one-third (29 percent) of this year's respondents said they still do not understand the details and implications, compared to 22 percent in 2011.
  • 16 percent said they'd like to see the ACA remain 'as is' (versus 11 percent in 2011).
  • 53 percent reported the ACA will have a detrimental effect on their ability to provide high-quality care, versus 50 percent in 2011. Forty-three percent more believe the ACA will be detrimental to the delivery of quality of care (from 14 percent in 2011 to 20 percent in 2012).
  • 26 percent want to see the entire ACA repealed (versus 21 percent in 2011).
  • Three-quarters reported that the meaningful use process is at least somewhat difficult and/or cumbersome.
  • More indicated ACOs as having a negative impact on quality of care (39 percent in 2012 versus 26 percent in 2011) and profitability (63 percent in 2012 versus 48 percent in 2011).

More EHRs purchased, more in use, but what do docs think?

  • 73 percent said EHRs are a distraction to doctor-patient interaction, up 12 percentage points from 2011.
  • The number who purchased an EHR jumped 10 percentage points between 2011 and 2012 (from 70 percent to 80 percent). However, 18 percent fewer voiced a very favorable opinion of EHRs (from 39 percent in 2011 to 32 percent in 2012).
  • 36 percent more believe EHRs somewhat or significantly worsen patient care (from 11 percent in 2011 to 15 percent in 2012).
  • 44 percent said the EHR was not designed with physicians in mind versus 32 percent in 2011.

Administrative woes

  • 89 percent said payers have become more intrusive on the patient-physician relationship versus 87 percent in 2011.
  • 74 percent said payers inhibit the care they would like to provide their patients (76 percent in 2011).
  • 59 percent more physicians see pay-for-performance as negatively impacting quality of care; 30 percent more believe it will negatively impact their bottom line.
  • However, 42 percent are very/somewhat confident their transition to ICD-10 will be smooth.

Independent physicians – fretting about the future of medicine, their viability

  • 81 percent do not see the future of independent practice as viable, representing 19 percent more doctors in 2012 than 2011.
  • This year, 50 percent more view the current healthcare climate as very detrimental to quality care delivery.
  • Unchanged from 2011, about two-thirds anticipate that the quality of medicine in the United States will decline over the next five years.