Unwise Choices: EHRs, PBMs, Drug Costs Are Leading to Physician Burnout

My dear electronic health records
How do I dislike thee?
Let me count the ways
Adaptation of Sonnet 43
By Elizabeth Barrett Browning, 1806–1861

As my tenure as physician editor winds down, it’s worth reviewing some of the more nettlesome issues confronting clinicians that have been previously discussed in these pages and gauge their current impact on our practices. These vexatious items include our dispiriting experience using electronic health records systems (EHRs), our agonizingly futile interactions with pharmacy benefit managers (PBMs) and our interminable challenges reckoning with absurdly priced pharmaceutical products.

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This holy trinity of healthcare misery provides the fuel for the raging firestorm of physician burnout. One major study confirmed that doctors suffer from burnout at a statistically higher rate than other occupations. [Compared with high school graduates, individuals with an MD or DO degree were at increased risk for burnout (odds ratio 1.36).¹] This finding should come as no surprise considering that primary care physicians devote an estimated six hours, or nearly half of their working day, solely interacting with their EHR.² Bob Dylan had it exactly right: Twenty years of schooling, and they put you on the day shift.³

Ten years ago, who could have imagined that our newly acquired EHR systems would become the critical driver of physician burnout? In a similar vein, who would have imagined we would waste so much of our precious time contending with the nefarious behaviors of PBMs? Who would have predicted the fallout from rising costs for branded and generic products, a concept predicated on companies being entitled to adjust the cost of their “mispriced assets” to levels they perceived the market could bear?⁴

Wasn’t technology going to unshackle us from our tedious chores and liberate us from having to deal with the sheaves of paper and faxes strewn across our desks? Wasn’t the 21st century going to be the era when “doctors could be doctors” and could focus solely on their patients’ care? In this brave new world, artificial intelligence would be sufficiently sophisticated so a smart robot could handle our tedious, clerical chores and, when needed, offer us timely clinical advice (see Rheuminations, “Machine Medicine,” February 2017). Instead, we are the robots, mired in the mud, tied and bound by the whims of insurers, PBMs and EHRs.

How Did We Get Here?

Let’s compare the rise of a technology that we love—the smartphone—with the EHR. Ten years ago, Steve Jobs, the late co-founder of Apple had it right: Take a music player, the iPod, add a telephone and a camera, and connect it to the Internet and cellular networks. Create an array of easy-to-use applications that came without detailed instructions yet were simple enough for anyone to use. Smartphones have transformed how we live. Just look around wherever you are and watch all those faces, transfixed on their phones. Nowadays, patients don’t mind if you are running late in clinic—if your Wi-Fi signal is strong, they won’t complain.