Doctors concerned about electronic health records

Being able to provide high-quality health care is a primary driver of job satisfaction among physicians, and obstacles to quality patient care are a source of stress for doctors, according to a new RAND Corporation study.

While physicians note some advantages of electronic health records, physicians complain that the systems in use today are cumbersome to operate and are an important contributor to their dissatisfaction, the study found.

The findings suggest that the factors contributing to physician dissatisfaction could serve as early warnings of deeper quality problems developing in the health care system.

"Many things affect physician professional satisfaction, but a common theme is that physicians describe feeling stressed and unhappy when they see barriers preventing them from providing quality care," said Dr. Mark Friedberg, the study's lead author and a natural scientist at RAND, a nonprofit research organization. "If their perceptions about quality are correct, then solving these problems will be good for both patients and physicians."

The findings are from a project, sponsored by the American Medical Association (AMA), designed to identify the factors that influence physicians' professional satisfaction. The issue is of increasing importance as health reform and other forces in the U.S. health care system alter contemporary delivery and payment models.

"Overcoming modern medicine's greatest obstacles to first-rate medical care can simultaneously enhance the quality of care and improve professional satisfaction among physicians," said AMA President Dr. Ardis Dee Hoven. "The AMA is committed to leading a national dialog regarding the major factors driving many physicians to feel increasingly disconnected from what really matters -- their patients."

Among the key findings of the study was how electronic health records have affected physician professional satisfaction. Those surveyed expressed concern that current electronic health record technology interferes with face-to-face discussions with patients, requires physicians to spend too much time performing clerical work and degrades the accuracy of medical records by encouraging template-generated notes.

In addition, doctors worry that the technology has been more costly than expected and different types of electronic health records are unable to "talk" to each other, preventing the transmission of patient medical information when it is needed.

"Physicians believe in the benefits of electronic health records, and most do not want to go back to paper charts," Friedberg said. "But at the same time, they report that electronic systems are deeply problematic in several ways. Physicians are frustrated by systems that force them to do clerical work or distract them from paying close attention to their patients."

Medical practices reported experimenting with ways to reduce physician frustration. Some employ additional staff members to perform many of the tasks involved in using electronic records, helping doctors' focus their interactions with electronic health records on activities truly requiring a physician's training.

Researchers say that physicians reported being more satisfied when their practice gave them more autonomy in structuring clinical activities, as well as more control over the pace and content of patient care. Doctors in physician-owned practices or partnerships were more likely to be satisfied than those owned by hospitals or corporations.

The study did not identify recent health reforms as having prominent effects on physician satisfaction, either positive or negative. Most physicians and practice administrators were uncertain about how health reform would affect physician satisfaction and practice finances. It was clear, however, that a common response to health reform was for physician practices to seek economic security by growing in size or affiliating with hospitals or larger delivery systems.

Other findings from the study include:

• Excessive productivity quotas and limitations on the time spent with each patient were major sources of physician dissatisfaction. The cumulative pressures associated with workload were described as a "treadmill" and as being "relentless," sentiments especially common among primary care physicians.

• Physicians described the cumulative burden of rules and regulations as being overwhelming and draining time and resources away from patient care.

• Perceptions of collegiality, fairness and respect were key factors affecting whether physicians were satisfied. Within the practices studied, frequent meetings with other doctors and other health professionals fostered greater collegiality and satisfaction.

Researchers based their findings on information gathered from 30 physician practices in six states -- Colorado, Massachusetts, North Carolina, Texas, Washington and Wisconsin. In addition to surveying physicians, RAND researchers visited each practice to conduct in-depth interviews with 220 physicians, medical administrators and allied health professionals to better understand the issues that drive doctors' satisfaction with their work lives. The practices included a wide assortment of medical specialties and organizational models.