I think it's gone a little too far - medical practice

[doctork]

Along the way here, you've caught some of my concerns regarding changes for the worse in healthcare in the US: lack of primary care docs and why, the burdensome regulations, the imposition of clunky EHR's that impair the delivery of good care - often because the doc is forced to spend most of his/her time with staring at the computer and typing.

Well tonight I received this recruiting letter from a recruiting firm that is generally well-regarded, but they have a client who wants their docs to pass a typing test:

//Dear DocK

We are offering $100/hour for this position in XXXXXXXX with Indian Health. Any state license is accepted and we can credential you to start within 2-3 weeks.

Need is ongoing with 2 month commitment required
Inpatient coverage preferred but will consider providers who can work outpatient only
Monday through Friday 8:00 to 5:00
1 hour unpaid lunch
BLS and ACLS are required
DEA preferred
Computer Literate - must type 30 wpm
Need to have 3 reference names and numbers when submitting CV
No overtime without prior approval//

I am astounded that the employer requires a typing test, but no residency or board certification! "No Overtime Without Prior Approval" - that means you will work 60+ hours per week but be paid only for 40, and if you cover in-patient, most of those unpaid hours will be nights and weekends.

Actually, there is no requirement that one be a doctor for this job, it's possible a driver's license will fill the bill; anyone can get BLS and ACLS, and the DEA (license to rx controlled drugs, which does require MD/DO credentials) is only preferred, not required.

Do they prefer that if you see a patient collapse in the parking lot as you leave after work, you check with management about approval of overtime before resuscitating the patient?

And of course, any implication that any primary care doctor ever gets an hour for lunch - paid or unpaid - is obviously fictional.

I'd rather work as a bank teller - I had fun at that job, and there was no blood, and no life and death melodrama.

[BoatBabe]

Sounds frightening. But for $100/hr? I'll bet there will be some highly unqualified people apply. And maybe even get the job.

[doctork]

$100 an hour is more than I have/will make at any family doctor job, but I am not bothering to apply. I know the clinic in question, and any entity hiring a physician really needs other priorities besides typing 30 wpm and requesting approval for overtime.

They must be seeking the bottom of the barrel. Or using an unprofessional recruiter. Too bad for their patients.

[liriodendron]

The faster you can type stuff into the charts, the faster you can see the next patient?

[doctork]

Yep, that's the theory: "Treat 'em and street 'em" as quickly as possible so the suits and bureaucrats can make more money. It is not primary care physicians whose numbers and earnings have risen over the past 20 - 30 years.

Actually, I can probably type at least 50 wpm, but the challenging is not typing, but clicking boxes and hunting for codes, and selecting the correct pharmacy for the eRx to go to. Figuring out the new ICD-10 codes is the hardest of all. If you have a patient who was injured as a passenger in a space craft, or stung by bees, that is easy - so long as you know whether the bee sting was accidental or intentional, or whether it was an assault by bees. I am not kidding, those are actual codes, easy to find. As is the code for "burned by water skis on fire" or "pecked by a macaw." But try to find laceration of the left hand and you will get a list of 600 items to scroll though and choose.

Many doctors are now hiring "scribes" to follow them around and enter the data for them, so the doc can stick to doctoring, not typing and coding.

PS - my next job will use an EHR (same one I am laboring to learn now) but I will know the system and its shortcuts by then, and will see only 1 or 2 patients per hour, which will allow me to spend most of my time with the patient, and less with the computer. That is why I am leaving - I like taking good care of patients as my #1 goal, not counting my through-put.

[gailkate]

Missed this (no surprise there) and once again find myself wishing you'd start a blog of some kind.

Funny, I never took typing because I absolutely didn't want to end up being everybody's lackey. It was assumed that women could type, so even the job of secretary of our faculty assoiciation was always a woman. Some of us refused and were seen as witchy and uncooperative.  But to say honestly "I can't type" was wonderfully liberating.

I'm guessing they didn't tell you typing was a pre-req for med school.

[doctork]

As it happens, I took typing in college - no, not "real" college where I got my BA, but the local community college when I was bored one summer. Still, I hadn't had to type for work until I became a health insurance executive, and even then I had an "admin" to do any heavy-duty projects, like polish a PowerPoint presentation; typing was not crucial to my clinical career until around 2007 when EHR became more widespread.

Early on in the 1980's, I thought the process of changing medicine from a cottage industry to a more efficient business model was likely a good idea and it could improve quality of care. Now I think the opposite: all that has happened is government and the corporatocracy have found ways to divert medical funds to line pockets of the 1% rather than care for patients. Scientific advances continue to improve outcomes a little bit faster then business/computers deteriorate quality, so things still look "OK" but we are about to see overall population health get worse. I suspect Millennials will be the first American generation in centuries to have poorer health than their parents.

As far as a blog - maybe when I retire. There are already lots of medical blogs, and I don't want the high profile or ongoing maintenance responsibility or liability entailed. Once a physician is writing for the general public, his/her location and identity are also public, and patient confidentiality is threatened.

Most employers, hospitals, large clinics specifically, and use bots more widely and many government entities monitor physician websites. I know of physicians who lost their jobs because of a remark seen as "uncomplimentary," and government investigations may be launched if a post is interpreted as a possible sign of illegal activity.

Once a non-physician (former) co-worker decided to start her own consulting firm and asked if I would be on her advisory board. I told her I'd consider it, but would have to check with our employer first. Unbeknownst to me, she listed my name and corporate affiliation immediately on her website. Within 24 hours, our CEO called me in for a meeting...the parent company headquarters spotted my name before I even had a chance to ask how our company felt about the request. I have had several threats against my life from crazy or disgruntled patients or their family members, so I am not anxious for a higher profile. I like to stay below such radar screens.

A book is a future possibility. I do have a viewpoint that is quite different from most other bloggers: The diversity of patients and conditions seem by family docs, my work overseas and in multiple varied US locations and cultures, my experience as a health insurance executive, and my work in health policy at both state and federal level.

I'll keep posting thoughts and vignettes here though.

[doctork]

(gk, scroll up before you read this, it's my second entry today!)

Another vignette. Remember, the plural of anecdote does not equal data, but worrisome all the same.

When I was doing hospital work, I occasionally encountered difficulty obtaining certain drugs or supplies in an emergency situation. It seems they couldn't be obtained/ordered/given/administered without first entering the order in the computer. Needless to say, if it is an emergency, you are too busy helping/saving the patient, and no one is running for the computer.

On my doctor sites, I read numerous similar stories of computers interfering with patient care, urgent or emergent care potentially delayed while going down the hall to the computer, or encountering some entry error on the computer.

Now all hospitals and clinics have "crash carts" with "all" the supplies needed for an emergency - but they are loaded with stuff intended for cardiac or respiratory arrest, and may not have what you need for obstetrical bleeding or a seizure patient or even Motrin for a child with a high fever.

And - once you open the crash cart, there will be a minimum of 20 - 30 minutes of paperwork (often electronic, but still "paperwork") to complete, in addition to checking and re-stocking the cart to be ready for the next emergency.

I am remembering that in Afghanistan, we all carried vials of the drug magnesium sulfate in our pockets in case the pharmacy was closed and we needed the mag to emergently treat a seizing pregnant woman (which happened 2 or 3 times a day there). Will doctors need to start doing the same here in the US so no patient dies while someone figures out the computer?