Young Doctors Swimming Upstream

Brian Klepper

Over the weekend we had a small dinner party, in which one of the guest couples’ daughter, a delightful 2nd year internal medicine resident at a major academic safety net health system, tagged along. Over the course of the evening, she told me many things that reflected the intense frustration that any young physician would have with the current system. The quotes below are paraphrased, but I’ve tried to ensure that sentiments expressed are accurate.

“My hospital uses EPIC, which is a terrible system. It’s unintuitive, and so many simple things that should be easy to find – a particular lab test or a diagnostic image with a certain perspective – are often buried and not easily found, even with the search function. I can spend 10 minutes looking for something that should be easy to navigate to but isn’t, which continually slows down my productivity. All the residents are frustrated with the way it wastes time by simply being at odds with the ways physicians think and work.”

“Learning a new, complicated electronic medical record (EMR) is like learning a new language. It takes time, but when I’m finished here and move to the next hospital, I’ll probably have to learn a different system, which will be an additional waste of time. The lack of standardization may serve the vendors’ interests, but its costly to health care organizations, clinicians and patients.”

“When I’ve called on the EPIC support staff, they’ve responded by asking whether I know things like my log-in and whether I’m computer literate. I’m 27 and, like nearly all my peers, I have used computers my entire life. I’m comfortable not only with Apple and Windows but with Linux. My sense is that the support people and maybe our own administration think that the difficulty is with the clinicians but, at this point, we know the difference between an ergonomic and a lousy application. The residents I work with believe that this is just a bad app, and that we’re stuck with it. Tools built like this slow us down rather than facilitate better care. I have to believe there are better designed EMRs out there.”

“In a 12 hour shift, I can only spend about 4-5 hours actually caring for patients. Most of the time is spent charting or trying to navigate insurance. I never imagined that this is how doctors would spend their time.”

“I’m assigned to the indigent care clinic, where I see many patients with serious problems but no money. We often don’t have specialists or diagnostics to refer to if there’s no insurance, so our options for caring for these patients are very limited. The patients are usually very aware that there are possible next steps, but there’s often nothing the physicians can do without coverage. It’s a shameful situation.”

Community Health Centers: Local Economic Engines and Cost-Effective Primary Care Providers

Jane Sarasohn-Kahn

First posted 8/09/11 on Health Populi

As the recession drags on and millions of people in the U.S. lack health insurance, there’s a community resource that extends primary care to them that’s not in a doctor’s office: it’s in Community Health Centers (CHCs). There are over 8,000 CHCs throughout the U.S., and 20 million people use them as medical homes — providing 25% of all primary care visits for low-income people in America.

At the same time, there are 60 million people in the U.S. who do not have access to primary care due to the maldistribution and shortage of primary care providers (PCPs). Access Endangered: Profiles of the Medically Disenfranchised, a report published by the National Association of Community Health Centers, details the growing challenge of filling the gap between the limited supply of PCPs and growing demand for their services.

The most convenient place for medically disenfranchised people to gain access to primary care is in the most expensive, if accessible, health provider setting: the closest emergency room.

The fact is that funding for Community Health Centers is scaling back, due to Congress’s recent reduction in the Health Centers Program midway through FY2011. This action, combined with the fiscal fact that other funding sources at the state and federal levels are threatened due to the economy and debt discussion, endangers CHC patients’ access to health care.

Continue reading “Community Health Centers: Local Economic Engines and Cost-Effective Primary Care Providers”