How physicians can help mitigate healthcare's 'recipe for disaster'

The U.S. is expected to be short 17,800 to 48,000 primary care physicians by 2034, and 1 in 4 physicians foresee burnout as a top reason to consider in their retirement decisions.

Tony Andrulonis, MD, a former emergency medicine physician and current president and COO of ScribeAmerica, joined Becker's to share his insight on the physician shortage, burnout, healthcare access and other topics. 

Question: What are your biggest fears in regard to the growing physician shortage?

Dr. Tony Andrulonis: It has huge ramifications. We have the aging population and more complex healthcare that's occurring among that population. Those people need more care. It's not just an increasing population head count, it's the complexity of care that's needed for each of those head counts in that population. To deal with all of those people, we need somebody to manage their care and not just put it all on specialists. There's an issue of not just the absolute number of positions, but it's the distribution of those physicians across different specialties. If we don't have enough primary care physicians, care doesn't get coordinated and patients don't get the efficient, value-based care they need because they're hopping from specialist to specialist. 

As the active physicians are aging, they start working a heck of a lot less hours and eventually retire. The newer generations are a lot smarter than us. And they want to have work-life balance. Younger physicians aren't working as many hours, so you have a head count shortage. On the provider side, that burnout that's been going on for years and years was completely amplified by COVID-19. Providers are burning out, younger doctors aren't working as much, older doctors aren't working as much and all of a sudden here comes this huge population that needs more care and more time than ever before. It's a recipe for disaster. We need to figure this out and try and solve it. 

Q: ScribeAmerica works to assign medical scribes to physicians. What are their full capabilities?

TA: Scribes are often thought to only solve the documentation burden within the EHR, but they do so much more than that. They are able to integrate with the care teams and provide support for a multitude of nonclinical tasks for that provider in real time, while they're working with the patient. The documentation and data entry part of it is a really important piece of it. When you have accurate and thorough clinical documentation, that helps to drive a lot of downstream effects, like care coordination, managing at-risk populations, value-based care metrics, real-world data for research initiatives, they help drive accurate coding for appropriate and fair reimbursements. There's a lot enveloped within documentation. There are a lot of other nonclinical scribes who can provide nonclinical support for tasks that providers would otherwise be burdened with doing, such as flow management, referral coordination and follow ups. We have scribes perform what we call "comfort rounds," when they do rounds on patients to provide nonclinical updates and address nonclinical needs of a patient while they're either waiting for a provider or waiting for results to come back. It helps to improve that experience for the patient and helps to improve clinical communication between the care setting and the patient as well.

Q: Did you use scribes when you were in practice? How did they affect your feelings of stress and burnout when you were practicing yourself?

TA: Around 2006, I became the chief of emergency medicine at an incredibly large ED in Miami. The physicians there were stressed, they were burning out. We had significantly long wait times. Patient satisfaction scores were nowhere near acceptable and there was a general feeling of burnout. One of the first things that I did there was introducing scribes. We were one of the first, if not the first, group in the state of Florida to utilize scribes in our practice. The changes that came out of that were really amazing. This was a site that was very hard to recruit physicians to when I first got there. When we got through all this, there was a waiting line of physicians wanting to join our practice. We had so many inbound inquiries we didn't even have to go out and recruit them — they came to us. We saw huge improvements in the efficiency of our physicians. People are focused on provider efficiency, but what that means for the patient is more access to care.

So when you think about efficiency from the provider lens, it's even more impactful to me personally anyway, when you look at it as an access issue from the patient side.

The last big piece is what I term as the provider-patient experience. It's that kind of magical moment in time when the physician and the patient are talking about that patient's very personal medical issues and their care plan. When the provider is able to give the patient their utmost attention and look him in the eye, sit down at the bedside and have that very important intimate conversation with the patient without disruption. How many times have you gone in to see physicians and they may not even be looking at you because they're sitting behind the computer screen tapping away or trying to look up this or they're trying to look up your own results or they're trying to they're trying to multitask — and so being able to have again and bring back that very intimate experience with the provider-patient experience is really important and what that leads to in metrics. 

Q: Have you ever gotten any negative feedback about scribes from patients or physicians?

TA: I would not say negative feedback, but there are times when patients may not feel comfortable having another individual in the room, and we can always accommodate that. That's when we would ask the scribe to step out of the room to finish that encounter. From a patient standpoint, scribes are very much seen as a part of the care team, so they've been very accepting of the patients by and large.

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