What do doctors want for the festive season?

To keep working healthily and in health care of course.

But what doctor would want to work in any health care institution these days? Especially when at least 25% of our practicing time is spent on administrative and quality issues. Sure, some administrative activities, such as patient scheduling or staff hiring, are part of the core activities of any practice. 

We can keep our clinicians healthy and in health care. 

However, newer administrative activities involving negotiating through the maize of complex billing, claims submissions and reporting requirements are asphyxiating clinical services world-wide. Increasingly complex electronic medical records, unsubstantiated quality measurements, risk adjustments, complex payment models, and prior authorization rules overlaid with a community distrustful and divided after the pandemic makes practicing today a nightmare. And it is not just in market driven, multiple payer countries such as the US, but also in the majority single payer environments of Australia and the UK. 

We can keep our clinicians healthy and in health care. Unfortunately, the solutions are as obvious as they are unpalatable. Remove doctors from the business of health care and return them to what they do best – care for patients. At the same time, work towards restoring patient trust and confidence in their doctors which has been lost in the pyrrhic quest for cost efficiency.

Sadly, when money drives health, cheaper models become synonymous with innovation. One way that is gaining traction is to triage the more straightforward clinical problems to less expensive providers such as physician assistants, nurse practitioners, medical assistants and scribes.  Only the complex, time-consuming consultations and long-term care with less likelihood of improvement in patient outcomes are left to doctors. 

In addition, the current trend towards concierge medicine exacerbates these problems by skimming off the worried well to an expensive private sector and extending their choice of service provider. The latter only gives rise to fragmentation of payers, which in turn generates more complexity in billing for all. 

No wonder patients and doctors are exhausted and dissatisfied. 

We can keep our clinicians healthy and in health care. It is time to jettison fee-for-service. It only worked in hospital environments where services could be clearly delineated, such as surgery.

Now is the time to provide non-hospital doctors with salaries and long-term benefits commensurate with the wholistic type of care that they want to provide and that our patients deserve to have. 

Perhaps in the future, contactless or contact-free services may make the non-clinical work of doctoring easier and non-hospital clinical services more amenable to other remuneration processes. Services such as untact (no contact), ontact (contact through online media), intact (interactive contact: no face-to-face communication), and digitact (digital contact or digital face-to-face) may facilitate a workable approach to fee-for-service or per capita payments by taking all administrative and quality functions backroom. 

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