Clinicians and management at odds in health care

In a survey conducted by a University of Pennsylvania School of Nursing team led by Linda Aiken, PhD, RN, of 21,050 physicians and nurses at 60 hospitals, it was found that more than 40 percent of clinicians were not confident that hospital management would act to resolve problems that clinicians identify in patient care. Close to one-third of clinicians said their values were not aligned with those of their hospital’s management. Twenty-nine percent of physicians and twenty-three percent of nurses reported that they did not feel free to question authority. This was a rather disheartening and eye-opening result reached by the survey.

We are aware of the serious repercussions of burnout in the health care professions. This condition began long before COVID-19 struck the world. In fact, in my opinion, the corporatization of health care has played a pivotal role in diminishing the satisfaction that physicians and nurses derive from their professions of attending to the sick. In the attempt by the corporate entity to remain solvent, more and more patients must be seen in a shorter time interval, leading to potentially less than adequate care for the patient. Both physicians and nurses have taken professional oaths to cause no harm to their patients, but it seems they are caught between the proverbial “rock and a hard place.” If they hurriedly move through appointments to keep the patient chain moving, they may not have the ability to address the issues the patient has, thereby causing the patient to feel unheard and underserved. The clinician feels resentment toward a system that puts the physician’s sense of professionalism and compassionate care toward his patients second in importance.

However, to take the corporate viewpoint for a moment, increased patient flow leads to increased profit to subsidize the ever-ongoing building construction and to cover the cost of salaries of administrative personnel. So what’s not to love?

Another area of contention is the electronic health record, which was supposed to be a boon to health care but has turned out to be a bust. It has become nothing more than a glorified “billing and coding” machine where physicians put in more time on this clerical task than what is spent directly dealing with their patients. It seems to me that the time a clinician spends inputting data could be better spent building a trusting relationship with his patient. Health care administrators, listen to members of your professional staff: Assign truly clerical tasks to members of the clerical staff or use more efficient forms of modern technology to perform this function.

A recent survey from the AMA, Mayo Clinic, and Stanford Medicine showed an alarming 62.8 percent of physicians experienced symptoms of burnout in 2021, up from 38 percent the previous year. Also, the study indicated that one in every five physicians and twice as many nurses planned to leave practice within two years.

The burnout of our physicians and nurses has reached epidemic levels. More and more of these professionals are leaving jobs in medicine and taking early retirement or seeking employment in other fields to regain a sense of work-life balance. Their calls for improvement in the health care environment for the past several years have, sadly, fallen upon deaf ears from all sectors.

For the patient, this translates into longer and longer waits and delays for a patient to seek medical care in the primary care office and also in the specialty areas, therefore putting health at risk.

There needs to be a significant overhaul of health care in the United States, with a close examination of the documentation of clerical tasks required by government programs such as Medicare and Medicaid and private insurance companies. For each hour of clinical face time a physician spends with his patient, an additional two hours are required to complete clerical and administrative tasks. Former president of the AMA, Robert M. Wah, made the following statement, “Physicians want to provide our patients with the best care possible, but today there are confusing, misaligned, and burdensome regulatory programs that take away critical time physicians could be spending to provide high-quality care for their patients.”

Individuals standing behind podiums and espousing nice-sounding phrases have not seemed to avert the health care crisis we find ourselves in: an ever-increasing shortage of physicians and nurses which results in those who remain on the job, overworked and at times, overwhelmed. All sectors of health care need to put aside differences and work toward solutions for the common good. If not, health care as we know it in America is “going straight down the tubes” and taking patients, physicians, and nurses with it.

It appears that the narratives of the patient, physician, and nurse have been effectively removed from the handbook of corporate medicine. This handbook needs a drastic rewrite. We all can agree that our current system of health care is strained to its limit and needs repair. Simplify and streamline paperwork mazes; let healing be the key in the process. Harness the use of technology with a conscience. If all sectors — health corporations, government, insurance, and pharmaceutical companies work together to develop solutions rather than creating additional roadblocks — maybe there remains a chance of righting the sinking ship of health care.

Michele Luckenbaugh is a patient advocate.