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<p>Probably not. They are busy working instead of arguing in circle on CC.</p>
<p>I’m looking at this San Diego Union-Times article. And it says, “Surveys suggest that older physicians are retiring in high numbers.” That’s not quite true. Surveys suggest that older doctors are making idle threats to retire, but in fact, older doctors are not retiring in higher numbers than usual. Also, “studies predict shortages as increasing hassles deter students from medical school.” Oh come now. Is there any evidence that we have a problem with not enough students applying to med school? Any evidence at all? Med school slots going begging? Nope.</p>
<p>Also, doctors, or at least some unspecified doctors referred to in the article, may say that EMR cut their productivity by 25%. But does anyone here believe that in the last few years, doctors’ productivity has been cut by 25% and we didn’t notice? Doctors are working 33% more time, or seeing 25% fewer patients, but somehow all the patients are still getting seen? Meanwhile, supposedly, older doctors are retiring at a huge rate, which would also cut in to the number of patients seen? This is all not true. Doctors may believe it’s true, but it isn’t.</p>
<p>I believe that doctors in solo practices, who are a small and shrinking percentage of all doctors, are having a tough time with electronic medical records. They have a tough time with the paperwork for insurance too. That’s a genuine problem. But pretending that the experience of solo practitioners is the experience of all doctors does not help us understand the full situation.</p>
<p>Can you link us to the post by frugaldoctor?</p>
<p><a href=“Affordable Care Act Scene 2 - Insurance Premiums - #6527 by frugaldoctor - Parent Cafe - College Confidential Forums”>Affordable Care Act Scene 2 - Insurance Premiums - #6527 by frugaldoctor - Parent Cafe - College Confidential Forums;
<p>I don’t know if this is true for everyone but it is for me. Purely anecdotal, but what I have noticed since EHR’s came into fashion is that I spend a lot less time waiting in the exam room for the doctor to come in. I remember a number of years ago, walking past my doctor’s office to the exam room and he was in his office dictating his notes on a patient when I walked by. Then I waited at least another 30 minutes until he came into the exam room. Now there is practically no wait at all (and the waiting room is no less full.) and my time with the doctor is no shorter than is ever was, either. </p>
<p>Now, maybe there are doctors who don’t like EHR’s but as a patient it is definitely a good deal. My PCP has been using EHR system since my kid was in middle school (he will graduate college next year) and my OB/GYN for at least 6 years. None of my doctors have retired, either. Also, none of my friend’s doctor husbands are planning on retiring any time soon, since they are still fairly young (mid to late 50’sish,) have big mortgages, college at $60/k per year per kid, trips all over the world to take, weddings to host, luxury car costs and their wives shoes and bags habit to support. Plus, most of them love what they do. </p>
<p>Frugaldoctor’s post says that some EMR systems are good (he liked one he used in 1999) and some suck. I can understand that he gets frustrated using bad software. What I don’t see is the way forward to good software that doesn’t involve an unpleasant shakedown trip, for some, through bad software, and also an unpleasant changeover from old systems to new, better systems that take time to get used to. We should have already made that shakedown trip, years ago, but we didn’t, and so now doctors and other medical professionals are being forced to do it. </p>
<p>What I also don’t see is the ACA detractors’ proposed alternative. We’re not going back to paper. We need interoperable electronic medical records.</p>
<p>Flossy, lots of systems suck. That’s hardly unique to the medical profession. </p>
<p>But I’m confused. Are you saying the systems should be fixed? Or are you saying the medical profession should go back to manual record-keeping? </p>
<p>Doug’s average payment in 2012 was $52.70 for a Doppler echocardiogram, which uses sound waves to peer inside a working heart. In 2011, the national average was $86.64.</p>
<p>So really, we want to draw conclusions from that? What he gets versus some vague and unspecified national figure? I linked something long ago that explained why they are reviewing reimbursements, how unstable it is, “nationally,” and how auto increases and their accurate reflection of fair charges hadn’t been reviewed since something like 2002. I also wonder how much of the Medicare “average” is also due to the issues cited with Medicare Advantage?</p>
<p>Med schools are increasing enrollment. I mentioned that, Texaspg chimed in about TX. The baby boom is ending and those older folks ARE retiring. If some 45 year old MD wants to quit over electronic requirements, I’m sure it’s not to go work at Best Buy, am sure he has made enough bundle to make that work out. </p>
<p>This comment is not for or against but anecdotal about some constraints related to EMR timestamping. A friend mentioned this week that the spouse was not available to go anywhere in the evening on days of work because the evenings are spent pretty much completing the records. The words used were, “there is hell to pay if the timestamp crosses midnight”.</p>
<p>Texaspg, what is the spouse actually doing while filling out the records in the evening? This is not snark. Whatever doctors do in that time is not obvious to patients and I’d like to know what it is. What is your friend’s spouse’s medical specialty, or is the person a primary care doc?</p>
<p>Also, is this new with EMR, or has the doctor always needed to fill out records at night? Previously, could the doctor wait a few days to fill the records out? I wouldn’t like my doctor to be writing about my case three days after she saw me; she’s a fine doctor but nobody’s memory is perfect.</p>
<p>Texas, hell to pay from whom? The partners? The office manager? The hospital corporation if they own the practice? </p>
<p>Days of work as in M-F? MTThF or what? We’re trying to understand.</p>
<p>What I understood was that the records need to be completed same day as patient visit. Don’t really care about it one way or the other.</p>
<p>My dad’s gerontologist was converting to EMR about a year ago. I could see that his doc, in his 50s I’d say, was working hard to figure out how to do everything. But during my visits this year, the change was complete and it was great that he had my dad’s history and medications at his fingertips. Yes, there is a learning curve for sure and I am sure there are some crappy systems. But it has to be a good thing. For sure I would rather have information entered in an orderly fashion in real time than at the end of a long day (or a long week), dictated, to be typed up and printed out. How accessible is that information? How much did the doctor forget between when s/he saw the patient and when s/he dictated the summary? When I applied to college, I had to fill out paper forms for each college, rolled into a typewriter to write my essay. Does anyone really think that’s better?</p>
<p>If the doc is entering information real-time – and it seems most of them do now – what are these mountains of information that have to be entered later which are consuming doctors’ evenings? And when did they chart this information prior to ACA?</p>
<p>I wonder that, too, LasMa. It doesn’t really make sense that they’d be doing this after a patient’s visit. Our doctors here have used electronic records for many years and I’ve never been at a visit where the doc did not enter what needed to be entered while she/he was sitting in the room with me.</p>
<p>There can be some info that comes in separately, of course. Or the doc followed up in some way (or reads that lab work) and writes notes. But the bottom line is, they had to do this in the past and will in the future. Nothing says typing it is so sadly much more work than writing, enough to throw the whole practice upside down. I don’t doubt some hate EHR or that some chose a bum system. But this is kind of like arguing that you can’t get an old tube tv. </p>
<p>If the issue is typing rather than dictating (and I am skeptical) why don’t the doctors just use DragonWrite or some other text-to-speech method? In my experience, most people who have a keyboard before them would rather use the keyboard than dictate, but if some older doctors would rather dictate, that’s fine… but how old are those doctors? I’ve been keyboarding my entire adult life. I know that people in our parents’ generation aren’t familiar with keyboarding, but my mother is 90 and my Dad would be 91. There are not a lot of people in that generation still practicing medicine.</p>
<p>The issue is not typing. The issue is a bunch of new forms to be filled out and questions to be answered that have more to do with bureaucracy than the practice of medicine. I don’t know what is so difficult to understand about this.</p>
<p>Flossy, catahoula yesterday nicely posted the actual criteria that an EMS system has to satisfy. Here they are again:</p>
<p><a href=“http://www.cms.gov/Regulations-and-Guidance/Legislation/EHRIncentivePrograms/Stage_2.html”>http://www.cms.gov/Regulations-and-Guidance/Legislation/EHRIncentivePrograms/Stage_2.html</a></p>
<p>I find your statement difficult to understand. Which of those criteria result in “a bunch of new forms to be filled out and questions to be answered that have more to do with bureaucracy than the practice of medicine”?</p>