Truth or myth?

July 10, 2019

Exposing the reality of the physician work ethic

A recent editorial in The New York Times, written by a physician who works at Bellevue Hospital in New York, has seemed to attract a lot of public attention. In “The Business of Health Care Depends on Exploiting Doctors and Nurses,” Danielle Ofri, MD, PhD, argues that physicians and nurses are victims.

Dr. Ofri offers some examples:

  • Your elderly patient’s son needs to talk to you urgently during your daughter’s recital > You work a double shift at the hospital to cover for your colleague who has a family emergency

  • You have a patient for a 15-minute scheduled visit, but the patient is complex and requires 45 minutes.

According to the editorial, the immediate reaction of doctors and nurses to do the right thing for patients “is being cynically manipulated.”

“If doctors and nurses clocked out when the paid hours were finished, the effect on patients would be calamitous. Doctors and nurses know this, which is why they don’t shirk. The system knows it, too, and takes advantage.”

The author, apparently a primary-care doctor, asserts that these demands on doctors have “escalated relentlessly in the past few decades,” patients are sicker today, electronic medical records take too much doctor time, resources are being misallocated, and doctors are burning out.

The article cites a Harvard Business Review statistic that for every doctor there are 10 non-doctor workers performing administrative and management duties. The author proposes that at least half of those positions should be given to nurses and doctors: “Heath care is about taking care of patients, not paperwork.”

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My own view is that things aren’t quite so bad, and this phenomenon is not quite as new as this article asserts. My observation growing up was that my father, a general surgeon, never “clocked out,” but seemingly worked all the time. Strangers would sometimes come up to me and tell me that my father had saved their lives with a 2 a.m. surgery on a ruptured appendix or a weekend cholecystectomy.

Helping people at all hours was what he did, and he loved doing it. With lower poverty rates and better nutrition today, are Americans really that much sicker today than they were 40 years ago? There is no question that young physicians can document in electronic medical records much faster than us oldsters.

So, allocating some of those non-doctor positions to scribes makes total sense to me. And the ever-growing federal regulations, expanding compliance requirements and Byzantine demands from insurers related to securing payment for services translate into an ever-growing need for workers who will never touch patients because they are busy generating reports and appealing denials for payment.

Patients’ needs top priority

While missing a child’s recital or sporting event is disappointing, our children will understand and forgive (as my father’s non-attendance at most of our games was a non-issue for me and my sisters). It is because most Americans believe their doctors and nurses will make their patients’ needs the top priority that we are held in such high regard by the public.

For this same reason, we are compensated extremely well compared with the vast majority of our fellow Americans, earning more than we have the time to spend. Is there an opportunity to better allocate tasks and reduce administrative and regulatory burdens on physicians and nurses so that they can spend more time touching and caring for their patients? Sure. Are we physicians (or at least we ophthalmologists) and nurses victims of exploitation? Not even close in my view.

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Disclosures:

Peter J. McDonnell, MD
E: pmcdonn1@jhmi.edu; P: 443/287-1511
Dr. McDonnell is the director of the Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, and chief medical editor of Ophthalmology Times.

References:

1. Danielle Ofri. New York Times, June 8, 2019 https://www.nytimes.com/2019/06/08/opinion/sunday/hospitals-doctors-nurses-burnout.html

2. https://hbr.org/2013/09/the-downside-of-health-care-jobgrowth