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    Letters: Readers comment on Medical Economics stories

    EHR system doesn't reduce the workload



    Michael McBride eloquently describes the tremendous demands on a primary care physician's (PCP's) time to practice in today's environment and still make a living ("Implementing an EHR can improve your lifestyle," December 25 issue). He argues that an electronic health record (EHR) system allows the physician to do much of the day's tasks away from the office. To the extent that a physician has to spend after-hours and weekend time at the office processing labs, calling pharmacies, and patients, I agree. However, I think McBride misses some salient points.

    First, I have yet to meet a practicing physician anywhere who will tell me that the benefits of an EHR on productivity are not outweighed by the cost and maintenance of the EHR and the loss of efficiency. I am also unaware, despite the universal mandates and incentives to adopt an EHR, of good-quality studies that demonstrate benefits to patients in regard to morbidity, mortality, and hospitalizations.

    But the biggest issue not touched on in the article is the workload itself. Why is it necessary to return to work after dinner or on a Sunday afternoon, whether to a physical office or virtual one? Saying "this is how it is" is not an adequate justification for the kind of lifestyle that leads to stress, divorce, or burnout. An EHR does nothing to rectify this problem and has at least the potential to make it worse. Until PCPs can make a living comparable to their specialist colleagues without working themselves into the ground, primary care will continue to struggle to find adequate numbers of residents willing to go into this field.

    LUIS A. VALLS, PHD, MD
    Portland, Oregon

    Private solo medicine soon may be extinct

    I have been a physician for 32 years. After more than a decade of working in a military hospital, a medical school clinic, and a hospital emergency department, I jumped in and did what I set out to do as a medical student: Open my own solo private family practice. It was the smartest professional decision I ever made.

    However, I fear that it is all about to disappear. I was there when managed care came along, and I was there when diagnosis-related groups were invented. Now after watching the development of the EHR, I have purchased my own. Do I like it? Not yet. Is it getting better? A little. There are two definite things I can say about adopting an EHR: It will cost you money up front and slow you down.

    Because of the increased overhead, continued payment reductions including more and more people without insurance (what happened there, President Obama?), and the inability to see as many patients in this new way of doing business, I fear that we dinosaurs—the private solo docs—are about to be extinct. I see my take-home pay decrease while my taxes, utilities, insurance rates, and supply costs increase. Where am I supposed to get the extra money to pay the difference? I am now considering laying off half my staff and increasing my hours at the age of 60 to 7 days a week to try to stay afloat.

    We can talk about meaningful use, EHRs, and medical homes all we want, but the bottom line is, private solo medicine will die in the next couple of years when all of us "old" veterans have thrown in the towel.

    THOMAS A. BRAGG, DO
    Moberly, Missouri








    Clarification

    The EHR Study Update in our January 10 issue incorrectly listed the amount of money the federal government has paid out in electronic health record adoption funds to qualified physicians. Through October, the government had paid out about $104.5 million in 2011. We apologize for the error.