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“Era of unhappy doctors” brought on by burnout, revenue woes

By Jennifer Bresnick

Shrinking Medicare reimbursements are sapping the willpower of formally dedicated physicians, asserts cardiologist Dr. Afshine Emrani in an opinion piece for the Jewish Journal, despite many of these physicians adopting robust health IT infrastructures to trim costs and keep patients out of the emergency room.  The “era of unhappy doctors” will only stretch on if professionals are not rewarded for their hard work, Emrani states, especially if outpatient physicians continue to see slow revenues despite doing their best to keep hospital-based spending lower.

“The largest cost of medicine occurs in hospitalization,” Emrani says.  “A single emergency room visit often costs more than the outpatient care of an individual for an entire year.   We are now armed with real ammunition to fight off cancer, keep diabetes under control, avoid recurrent hospitalizations for heart failure and cure many infections in the office setting.  Aggressive outpatient practice that serves as both primary care and urgent care can save the system huge sums by avoiding hospitalization and/or even recurrent readmissions.”

Emrani details the steps he has taken to significantly reduce his patient hospitalization rates, including providing patients with his email address for quick inquiries to diffuse panic that may lead to an ER visit, using his EHR system to renew prescriptions, and keeping all data from the past decade on hand to ensure comprehensive treatment.  Emrani also uses physician assistants to triage patients, provide initial care, and handle walk-in patients, and he ensures that all patients are seen the same day when necessary.

But despite the efficiency and comprehensive scope of his services, burnout is always close at hand.  “Physicians like me work long hours and without much break.  This plea is by no means self-applauding,” he writes.  “I am not alone.  Many of my colleagues have done the same and boast curing conditions on an outpatient basis and keeping complicated patients out of the hospital.”

“However, in the past year, there has been a palpable shift in attitude.  Many have lost their motivation to work that hard.  The increasing overhead of running such a practice along with dwindling reimbursements are forcing many to reduce the cost of their systems and push patients to the emergency room.  I am seeing an alarming increase in number of good physicians who just don’t care as before.  They will do their obligation, and instruct their front office to direct overflow patients to the ER!”

Physicians complaining about stresses on the healthcare system is nothing new, but as the ACA brings in a flood of new patients and professional shortages threaten an already-strained industry, providers are looking for anything to relieve the burdens that have led many to complain that they are nothing but glorified data entry clerks bound by the chains of pointless governmental mandates with little inventive to go above and beyond the basics of patient care.

“Let outpatient doctors stay in their offices and incentivize them to cut hospitalization rates and ER visits,” Emrani urges.  “Let the hospitalists handle the acutely ill inpatients and return them back to the office promptly.  And let the two groups of doctors cooperate and deliver the type of care for which this country was once blessed, with fulfilled doctors resulting in happy and healthy patients.”





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