Blog | Friday, October 27, 2017

Ban the term productivity from medical care

According to Wikepedia:

“Productivity describes various measures of the efficiency of production. A productivity measure is expressed as the ratio of output to inputs used in a production process, i.e. output per unit of input. Productivity is a crucial factor in production performance of firms and nations.”

Please tell me how this relates to being a physician or a patient. We do not produce anything. Rather we work with individuals to diagnosis, prevent, treat, and hopefully improve both longevity and quality of life.

Physicians work with individual patients. We should strive to tailor care with our patient.

Productivity implies that we can count patient units. That idea really disrupts the essential Why question?

If you are unfamiliar with why I highly recommend Simon Sinek's book Start with Why. Why did we become physicians? I think the answer for most physicians includes helping individual patients. We strive to do our best for each patient.

Where did productivity enter our profession? Most experts believe that Hsaio's NEJM article – Estimating Physicians' Work for a Resource-Based Relative-Value Scale led to RVUs (relative value units) which many practice administrators use to measure “productivity”. Hsaio, a noted economist, wrote in the abstract of that article:

“We found that physicians can rate the relative amount of work of the services within their specialty directly, taking into account all the dimensions of work. Moreover, these ratings are highly reproducible, consistent, and therefore probably valid.”

However, this model has led to gaming the system, and equating RVUs with hard work or productivity. But many physicians believe that the RVU system provides many wrong incentives, the most important being that shortening visit time leads to more patients per day and thus more money.

I wish physicians could just ignore RVUs and spend appropriate time with each patient. When physicians try to do this, practice administrators work to get physicians to see patients faster.

This leads to great stress for many physicians, and often unhappy patients. Many physicians believe that shorter visits (especially with primary care physicians) lead to more testing and consultations.

Productivity implies that seeing more patients each day is a good thing. But likely most patients and physicians will agree that we need to optimize the time with each patient. How many patients can we comfortably see in one day and deliver high quality care? High quality care does not refer to performance measures, but rather complex multi-dimensional factors that improve the patient experience. For many patients, talking is both therapeutic and diagnostic. We shorten our conversation time at the risk of diagnostic errors, higher health care costs and dissatisfied, confused patients.

So please join the movement to ban productivity from medicine. We are not producing anything. We are caring for patients who need our full attention.

db is the nickname for Robert M. Centor, MD, FACP. db stands both for Dr. Bob and da boss. He is an academic general internist at the University of Alabama School of Medicine, and is the Regional Associate Dean for the Huntsville Regional Medical Campus of UASOM. He still makes inpatient rounds over 100 days each year. This post originally appeared at his blog, db's Medical Rants.