In a recent Rand study, doctors said being able to provide high quality healthcare is the primary driver of their satisfaction. However, the study also found the number of factors contributing to dissatisfaction is becoming almost insurmountable.

Electronic health records (EHRs), widely touted as technological tools to improve patient care, have in fact increased physicians’ workloads and administrative burdens. Additionally, as revealed in that same Rand study, physicians complained that their digital record systems are interfering with face-to-face encounters with their patients. Physicians recognize the over-hyped promise of EHRs – having relevant patient data at the time of visit – and the reality of incomplete information because lab, x-ray, and pharmacy systems are not interoperable. Couple the burden and disappointment of inadequate EHRs with the added obligation of entering data to a patient record at the rate of 30-40 keystrokes per patient, and physicians are left with much less time for real patient care.

Yet Washington appears to be convinced that technology is the answer to better care, even when physicians will tell you that better care depends on listening to and examining the patient through their history and physical – albeit technology has a role in diagnosis and confirmation of findings. As Kevin Pho, MD recently pointed out, and confirmed by many physicians we know, they often have to spend more time “checking boxes with a mouse to satisfy onerous billing and administrative requirements that do little to help patients.” More time in front of computers equals less time for patients.

In fact, a study in the American Journal of Emergency Medicine found that emergency physicians spent 43 percent of their time entering data into a computer, compared to only 28 percent of their time spent talking to patients. It went on to say that “during a typical 10-hour shift, a doctor would click a mouse almost 4000 times.”

In his new autobiography[1], U.S. Defense Secretary Robert M. Gates makes reference to how the Defense Department was so enamored with technology that it undervalued its most important asset – human intelligence. Perhaps the federal government still has not learned this lesson on the domestic side. The Department of Health and Human Services values EHR technology and its role in the doctor’s office – referred to as meaningful use – as the standard of care; thereby undervaluing our most important asset – the physicians’ knowledge, education, training, and intelligence. The physician is demoted to a keyboard operator so that the government’s Holy Grail – personal information – can be entered into its massive database. Given its track record in protecting personal and confidential information, the public has much to fear from medical and health data collection by the federal government.

But EHRs are saving money, so it’s worth it, right? Not exactly. The once predicted cost savings due to EHRs is somewhat in question today. As Dr. Pho points out, a 2005 Rand Corporation analysis predicted that they would save $81 billion annually. Admittedly, those numbers were overstated.

Another area that impacts overall physician satisfaction is practice setting. The Rand study confirmed that physicians want to work with and for other physicians, as well as for hospitals. However, hospitals take away physicians’ clinical autonomy and try to control the content and time spent with each patient. Physicians, meanwhile, understand the need to treat each patient individually and not as just another number in the hospital’s panel of enrolled patients. Unfortunately, the trend is toward hospital employment with productivity quotas and severe limits on the time a physician may spend with the patient.

Deloitte reports that the number of physicians directly employed by hospitals increased 45 percent from 2000-2010. Further complicating the picture is the fact that hospitals can lose up to $250,000 per year per employed physician. But this has not stopped the hospital systems’ bull-rush to employ as many physicians as possible. According to Rand, excessive oversight by the hospital system is a major contributing factor to physicians’ dissatisfaction and lost productivity. In fact, physicians find that the contracts they sign with hospitals turn out to be so unreasonable that a majority leave after their two- to three-year term expires. This creates significant continuity of care and access problems for the patients at the employing hospital system.

Rand makes clear that money doesn’t drive physicians, but income stability and fair treatment from payors, including the government, substantially improve their satisfaction. Ask any patient care physician what his or her goal is, and the answer invariably will be, “To provide the best possible care and outcome for my patient.” And this is why the new era of government mandates, rules, and regulations is detracting from medicine’s primary mission. It is not about collecting the most patient information and personal data possible; it is and always has been about providing care and cure. Somehow this simple, yet basic principle has been lost along the way of building massive, impersonal systems with layer upon layer of red tape and hassle.