If you were asked to name the turning point of the year 2020, you would probably suggest March 11, when Covid-19 was declared a worldwide pandemic by the World Health Organization. With rapidly increasing numbers and an alarming infection rate, the virus spread through continents like wildfire. It upturned billions of lives, shut down businesses, and practically decimated the elderly population in many countries.
Amongst many of these casualties was the healthcare system itself, which wasn’t prepared for the surge of patients Covid-19 would bring to its door. As the emergency rooms remained open, the wards became overcrowded, and healthcare workers (HCWs) clocked in 12+ shifts; the problems faced by physicians started changing.
The healthcare industry has proceeded to a recovery phase in 2021. Yet, the problems physicians face persist. In this article, we’ll discuss the biggest challenges facing healthcare in 2021. These are both general problems that doctors face in the healthcare system and those specific to the pandemic.
1. Physician Burnout
As discussed above, the new working conditions since 2020 have immensely increased doctors’ workload intensity and duration. However, according to a 2020 Medical Economics Physician Burnout Survey, only 12% of physicians cited the pandemic as a reason for burnout. This shows that the profession, even in normal conditions, is mentally and physically taxing on physician health.
31% voted ‘too much paperwork and employer regulations,’ and 15% voted ‘poor work-life balance, working too many hours as the top two reasons for experiencing burnout. A whopping 91% of physicians voted ‘yes’ to having felt burnt out at some point in their career.
Another cause for the increased workload in 2021 is the newly activated telehealth service. The pandemic frenzy and precautions forced the shutdown of many clinics and practices worldwide, making telehealth service a viable option to stay in the field. According to a Medical Economics technology survey, 93% of physicians have started using telehealth services since 2020. It is also common now for doctors to physically work in hospitals for long hours during the day and top it off with a couple of hours of seeing patients via telecommunications.
Burnout can present itself in different ways:
- Emotional/mental burnout, causing the development of disorders like depression and anxiety
- Physiological burnout, presenting as headaches, lowered immunity and increased blood pressure
- Behavioral burnout, causing changes in sleeping habits, consumption of alcohol or nicotine, overspending, etc.
Although not much can be done to reduce patient influx or negate the convenience of telehealth services, physicians must identify symptoms of burnout and mitigate its effects at the earliest by:
- Having a healthy diet, free of drugs and artificial sugar
- Getting 7-8 hours of good quality sleep
- Reducing screen time before bed
- Exercising consistently, even if it’s twice a week. It should be a healthy mix of aerobic/cardio and muscle-building exercises.
2. Paperwork/EHR
Another major problem that physicians face is the paperwork attached to each patient. According to a 2016 study, physicians spend 50% time in administrative work and only 27% on the actual patients and listening to their grievances. Spending less time with patients due to record-keeping and administrative measures irks physicians as most of them feel such responsibilities burden their primary healthcare duty.
Although electronic health/medical records (EHR/EMR) were introduced to streamline data collection, it is seen as just another time vacuum by doctors that are more interested in being attentive to the patient. Additional authorization requests to payers before any treatment or medication also rank high on the list of grievances physicians have regarding paperwork.
This paperwork dissatisfaction is also linked to physician burnout, cited as the most common reason for burnout in the survey. The significance of EMRs in providing value-based patient care cannot be dismissed, but some measures can be taken to reduce physician responsibility.
- The number one tip to reduce this burden is to employ scribes to take the burden off physicians’ shoulders, increasing productivity and job satisfaction. Team documentation is important, and it leaves the real diagnoses job to the MD while delegated further tasks.
- The EHR vendor can also be negotiated to streamline the data collection process, such as providing automated prompts specific to the patient’s health concern and eliminating unnecessary steps.
- Another tip is to employ indication prescribing: input a short note on the purpose of the medication for the top ten used medicines.
3. Getting Paid
Getting paid consistently and fairly is also a significant problem doctors face. Reimbursement is more than just getting paid; it is often a long and arduous documentation process, starting from when the patient first enters your clinic. This calls for a high degree of familiarity with medical coding and understanding the basics of the Medicare system. Having a solid grasp over Centers for Medicare and Medicaid (CMS) E/M coding is imperative to ensuring maximal reimbursement and preventing reimbursement denials.
The 2021 changes in CMS coding put physicians at an advantage. They have now made it easier for physicians to choose between medical decision-making (MDM) or total time spent on the date of the encounter – whichever pays more, as long as documentation supports medically necessary services.
Remember, physicians are only paid for the services that are documented. So honing the documentation skill will prove financially fruitful and add to your value-based patient care ethos.
To make sure you are maximizing reimbursement, you must:
- Frequently refer to E/M coding guidelines. Ensure that the code assigned supports the encounter, as E/M coding is not subjective
- Provide reasonable and necessary services
- Remain cautious with EHR copy/paste functions. Although time-saving, old records can cause up-coding that will raise red flags with the payer
4. Ethical Dilemma
The ethical dilemmas facing doctors under the blanket of Covid-19 have increased, especially for frontline workers. Critical care workers are constantly choosing between patient life-and-death situations, personal priorities, and another patient’s needs. How does a physician choose between the patient’s needs and their inability to pay for the service? Or balance their duty towards Covid patients while fearing for passing the disease on to their own family?
How does a doctor decide who to use ventilatory services for, a critical patient with less likelihood to survive or a less critical patient with a better prognosis? How does a physician make decisions for expensive end-of-life medical care that only delays the inevitable?
These are only some of the difficult and controversial decisions healthcare workers must make daily, and these significantly contribute to burnout or emotional stress.
See Also: Is There a Shortage Of Physicians And Doctors In The U.S.?
Conclusion
The healthcare profession is a high-stress way of life. The ability to adapt and have well-honed coping mechanisms is of vitality to survive in such a field. Having a set of values, knowing the ‘why?’ behind each medical recommendation, each E/M code, and each ethical choice helps physicians stay in touch with their conscience and make better choices in the best interest of the patient, themselves and the healthcare industry at large.
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