EHRs hinder physician job satisfaction

Providing quality care to patients is the main source of job satisfaction for physicians. However, EHRs are putting a dent in that satisfaction, as many physician see them as a source of stress and an obstacle to quality care, according to a 150-page report published by RAND Corp. and sponsored by the American Medical Association.

The study analyzed data between January and August 2013 from 30 physician practices in six states—Colorado, Massachusetts, North Carolina, Texas, Washington and Wisconsin. RAND researchers conducted semi-structured interviews with 220 practicing physicians, practice leaders and other clinical staff querying factors that influenced professional satisfaction with their practice, the local healthcare system and the regulatory environment. RAND also received 447 responses to a field survey of these 30 practices.

Those surveyed voiced concern that EHR technology interferes with face-to-face interactions with patients, requires physicians to spend excessive time performing clerical work and undercuts the accuracy of medical records by encouraging template-generated notes, according to the report. High costs to implement the technology and lack of interoperability between systems also worried physicians.

To cope with physician frustration, practices reported employing additional staff members to perform some EHR tasks.

In other findings, physicians reported greater satisfaction when their practice gave them more autonomy in structuring clinical activities, as well as more control over the pace and content of patient care. Doctors in physician-owned practices or partnerships were more likely to be satisfied than those owned by hospitals or corporations, the report also found.

Healthcare reform did not have prominent effects, either positive or negative, on patient satisfaction, with most physicians and practice administrators uncertain about how it will affect practice finances. However, consolidation often occurred with practices seeking greater economic security.  

Other study findings include:

• Excessive productivity quotas and time limitations on patient encounters were major sources of physician dissatisfaction.
• Rules and regulations overwhelmed physicians, as they felt they drained time and resources away from patient care.
• Perceptions of collegiality, fairness and respect were critical factors affecting whether physicians were satisfied.

“Physicians believe in the benefits of EHRs, and most do not want to go back to paper charts. But at the same time, they report that electronic systems are deeply problematic in several ways. Physicians are frustrated by systems that force them to do clerical work or distract them from paying close attention to their patients,” wrote Mark Friedberg, MD, study lead author and a natural scientist at RAND.