Clinicians of the Future Report, Part 2

I’m slowly making my way through the Elsevier report that I discussed last post[1] (all 116 pages of it). While I can relate to most of the findings, it’s still astonishing to read a global report that highlights the exact concerns that I have experienced in my career. It’s tempting not to generalize my experiences and to think that things must be done better in other states or countries, but this report shows that globally, we have some real changes to make. Most other clinicians I know or have worked with feel like it’s futile to try to change the system. They show up, do their best in the moment, as the current moment exists, and then return the next day to the same conditions…knowing that at some point they’ll probably burnout and change careers. But, with this huge compilation of data, I feel like it is possible to get information about our experiences to key decision makers…administrators, policy makers, and insurance providers. As people who will at some point require health care, these decision makers have a vested interested in ensuring that there are enough providers still working when they or their family members need care. Today, I want to discuss the findings about provider beliefs about patient interactions. In this section, the authors address over-scheduling as well as patient satisfaction/empowerment, listing both areas as contributors to provider burnout.

Let's talk about over-scheduling first. As providers, we are often juggling multiple patients and racing to complete the required interactions, as well as documentation. As patients, we are all familiar with the 8 minute doctor visit, during which no one makes eye contact and actual health is never discussed. 51% of providers globally felt that they had enough time to provide good care for their patients. This was highly variable based on region, with Western and European countries demonstrating much lower percentages. In the United States, 44% of providers felt they had enough time to provide good care. The lowest scorer was Germany, with only 15% of providers agreeing to the same statement. Now, I want to bring in data from an older study[2] (which I discussed in a previous post), indicating that while 75% of orthopedic surgeons felt they did a good job communicating with their patients, only 21% of patients reported satisfactory communication. So if, for instance in Germany, only 15% of providers feel they have enough time to provide good care for their patients, what could actually be the percentage of patients who feel they have received good care?!

In the United States, we like to talk about a shortage of nurses and physicians, but this is a classic trick of capitalistic medicine. Health care, as it is designed today, is based on optimizing the total number of patients one provider can treat, without it being blatantly dangerous. Profits are higher when there are way more patients than providers. Currently in the US, people who have graduated from medical school and earned the title “MD” still need to complete residency training in order to become practicing physicians. In 2021[3], 42,508 medical students graduated from medical school, but only 35,194 residency positions existed. This means that 7,314 potential physicians were not able to complete their training to become actual providers. Imagine that this happens every year (it does). With more physicians, we could give each patient longer appointment times, improve quality of care, and decrease provider burnout rates. CMS (Center for Medicare and Medicaid Services) pays for most residency programs, so actually the residency bottleneck is a direct result of governmental policies, which have not been updated since 1965. This is an actionable item that could make a tangible difference in the patient and provider experience.

The other main point of this section is that providers feel frustrated with the “consumer” movement in health care, which is demonstrated when people come to appointments with preconceived ideas about what their diagnosis might be and what kind of treatment patients expect. This comes from increased health literacy, increased consumer culture, and increased access to things like WebMD and Google. Patients often have to wait a long time between calling for an appointment and actually seeing a provider (not uncommonly waiting months). Today's patients have plenty of time to dig for information and talk to friends prior to their appointments. Providers see this shift away from the paternalistic medical care of decades ago, and they recognize that it requires increased patient/provider collaboration when making a treatment plan.

The study discusses the idea that patient empowerment and consumer-ized medical care will require providers to display more variable types of empathy. I would argue that they actually needed to be talking about compassion, but empathy is the language the authors used. In their own words, “While the role of empathy will not change much for patients who need a more traditional approach to healthcare, it may look different for empowered patients. For example, they might not need comforting face-to-face conversations, but rather to be heard, believed and involved in decisions.” I would challenge any of the authors of this study, as well as any of the participants in this study, to identify a human in need of medical care who did not feel the need to be heard and believed. How can any medical provider make an accurate diagnosis or provide an adequate treatment if we aren’t actively listening and evaluating the patients’ experiences inside their own bodies? Never mind that, by tapping into the huge healing and pain reducing benefits of compassionate care, medical providers can improve patient outcomes, improve health, and guarantee a positive patient experience.

Startlingly, a follow up statistic to the statement of need for increased empathy comes on the following pages, “Only 18% of respondents to the Clinician of the Future survey believe empathy will be one of the three most valuable capabilities for clinicians in 2031 – a decrease from the 29% who rank empathy as such in 202.” Only 18%!!! To me, this is the entire problem with global health, in a statistic. I would bet big money that 100% of patients place empathy or compassion in the top 3 most valuable capabilities for health care providers every single time. People want to be seen, heard, understood, and cared for. It’s a basic human need. We need to be including compassion training in all of our medical education programs, or at the very least the data about the health benefits of providing compassionate care, so that clinicians of the future do not overlook or undervalue the “soft skills” in medicine. Of course cutting edge treatments are important. Of course diagnostic tools, big data, and technology are critical. But without listening to and connecting with patients, all of that is useless.

I think these data points about patient empowerment and sufficient time allowed for each patient are two sides of the same coin. When patients have greater health literacy and have been thinking/researching about their own health and possible treatments, they come to appointments with questions. When providers offer different diagnoses or treatments than patients expected, people have questions. Effective patient care, in the era of consumer medicine and empowered patients, requires time for discussion of patient ideas vs provider ideas, with enough time for transferring knowledge from provider to patient, mutual decision making, and recruiting patients to take active roles in their own care. These conversations require compassion, and compassion should be an integral part of health care education. Removing the artificial bottleneck on available providers could free up some personnel resources to allow for this type of patient care. Today’s providers are burning out quickly, and these tangible solutions could make a difference in the number of health care providers available in the not so distant future.

[1] https://www.elsevier.com/__data/assets/pdf_file/0004/1242490/Clinician-of-the-future-report-online.pdf [2] https://healthliteracycentre.eu/wp-content/uploads/2015/11/Tongue-2005-.pdf

[3] https://www.vox.com/22989930/residency-match-physician-doctor-shortage-pandemic-medical-school