Authors of a new article say the trend of physicians devoting more time to mandatory tasks that are not directly related to patient care can be reversed, which would improve the quality of patient care even as it increases physician satisfaction.
David Reuben, M.D., and Christine Sinsky, M.D., discuss how to bring about the change in the article "From Transactional Tasks to Personalized Care: A New Vision of Physicians' Roles,"(www.annfammed.org) which was published in the March/April issue of Annals of Family Medicine.
The two authors note that many physicians report having less control of how they manage their time each day, citing administrative demands such as electronic health record data entry that take time away from patient care and contribute to burnout.
"There is a gap between the professional mission physicians want to do and what physicians spend a substantial portion of their time and energy doing," they write.
The remedy Reuben and Sinsky recommend begins with assigning certain transactional duties to nonphysician members of the health care ecosystem who have less training. The authors point to nursing, pharmacy and physical therapy as professions that successfully employ such delegation, but they acknowledge that physicians encounter barriers to doing so.
"Too often, team care is compromised because physicians cannot or do not share aspects of care with others because of cultural, organizational, regulatory or technology barriers that force physicians to perform transactional tasks," they write.
But overcoming these barriers would allow for more appropriate assigning of duties such as most preventive care, data-gathering, documentation and disease-specific patient education. This would free physicians to spend more time creating individual care plans for patients, managing multiple conditions and performing procedures. They also would have more time for the transactional tasks that do require a physician's training and experience.
"Physicians may need to perform some transactional functions that require shared decision-making, such as deciding whether to screen for prostate cancer," the authors write.
They also call for changes to the health care system outside the clinic. For one, the medical training curriculum needs to help physicians sharpen their communication skills to allow for more effective interactions with patients, other physicians and nonphysician members of the care team.
On another front, payers need to shift from measuring completion of transactional functions to measuring aspects of personalized care that physicians can control, and physicians should be compensated for care even if it occurs outside of an office visit.
Bringing about these changes would require coordinated work across the health care system, but the effort has potential to enable much-needed improvement.
"Making the shift from current unfulfilling transactional roles to focus on the great value inherent in providing personalized aspects of care will be a triple win -- for patients, physicians and society," the authors write.
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