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Shorter physician work week reflects changes in activities

From the April ACP Hospitalist, copyright © 2010 by the American College of Physicians

ACP HospitalistWeekly quoted a JAMA article saying that doctors have cut their work week from 55 to 51 hours (“Lower pay drives doctors to cut hours,” March 3, 2010). I have a pretty strong opinion on this. I work in an office about 80% of the time. The other 20% of the time I work in the hospital. Since I don’t believe there has been a new office internist in the U.S. since about 2004, I am sure that these changes reflect not lower hours from new hires so much as changes in the work activities of currently employed internists.

My career prior to medicine was as a computer programmer so it’s not like I’m anti-technology. But my patient hours in the office have shrunk considerably since we started using an electronic medical record (EMR) system in 2006. My work week has expanded because, beginning this year, I spend more time completing charts and filling out forms than seeing patients.

In our clinic of nine physicians, every single one of us has had to cut patient contact hours to serve as our own transcriptionists and data entry personnel for the insurance companies. For every hour that I see patients, I spend about an hour and 10 minutes filling out the multitude of boxes in our EMR. The largest staff-model HMO in our area shows physicians logged in for 102 minutes for every 60 minutes of patient appointments. They use a different system and have a fuller complement of information technology staff, lowering their salary but improving the computers’ responsiveness and usefulness, I am sure.

For those of us who use office visit notes, the EMR has been an opportunity to do every bit of clerical work that can possibly be crammed into a screen, using the cheapest, slowest technology that meets the government guidelines. I am sure that this is a net savings for the system, which is then able to lay off transcriptionists and probably streamline accounting. What a cost savings to have physicians who get paid by the visit do more and more and more work to get the relative value unit of about $21 an RVU, which takes me 30-40 minutes to earn. I am making about $40 an hour, which is about one-third of what an accountant charges me.

Lynn Bentson, FACP

Albany, Ore.

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ACP Hospitalist provides news and information for internists about the practice of medicine and reports on the policies, products and activities of ACP. All published material, which is covered by copyright, represents the views of the contributor and does not reflect the opinion of the American College of Physicians or any other institution unless clearly stated