The New York Times recently published a very touching, well-crafted article detailing the plight of a solo physician in small-town Maryland. Dr. Ronald Sroka has seen his once-lucrative practice diminish to a point where, as the headline notes, “Family Physician Can’t Give Away Solo Practice.”
The description of his practice—one centered on friendly, intimate chats with patients—almost recalls the era of the horse and buggy. This physician, like many of his middle-aged peers, has seen medicine lose so many of the characteristics that made it appealing in the first place. Relationships with payers have become more contentious, and the pressure to squeeze in more and more patient visits just to break even has become intense. As the Times points out, the physician entering medicine today no longer is as interested in the long hours and on-call rotations that have long characterized the field.
The article notes that the electronic patient record may prove to be the straw that broke the camel’s back for Dr. Sroka. “The new policies that may finally put Dr. Sroka out of business are almost universally embraced — including wholesale adoption of electronic medical records and bundled payments from the federal Medicare program that encourage coordinated care.” For one thing, he has little money to invest in an expensive software package, and for another, he probably has little interest in upending a lifetime of practice habits and well-worn routines that keep his staff of ten employed.
The meaningful use program, of course, is intended to counter just that sort of obstacle—which is commonly felt in an industry where the majority of group practices have yet to adopt EHRs. But financial incentives often hold surprisingly little sway in the health care world, particularly when they are viewed as unattainable by an audience that has long feasted on fee-for-service reimbursement models. The American Medical Association recently put out a plea—a nine-page treatise to be more precise—calling on CMS to ease the collective burden of its regulatory programs. Taken in total, the programs represent a confusing, often conflicting, array of reporting measures and compliance efforts, some EHR-related, some not. So it’s no wonder physicians like Sroka seem reluctant to embrace the electronic future. They associate it with the regulatory maze that all too often defines health care.
Now I’m not suggesting a return to the paper chart—and all the woeful inefficiency and non-standard care it symbolizes. But I do fear that if health care loses that personal touch represented by physicians like Sroka, it will be a loss that no amount of EHR sophistication could ever replace.
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