If physicians are less productive, here’s why
Health-care system’s inefficiencies, outdated technologies, are among the reasons, Adam Hofmann says.
A recent Quebec government-commissioned report linked increasing physician pay with lower physician productivity. Casting physicians, themselves victims of the system’s inefficiencies, as the villains here would be hugely unfair.
In Quebec, there are significant barriers to both the quality and quantity of medical work.
As a specialist physician and the founder of two Quebec-based health-technology companies, I am doing all I can to increase patients’ access to medical care by applying technology to co-ordinate care more efficiently. But to collate and analyze the data I use to assess a patient in the hospital, I have to open and consult up to eight different, non-integrated computer programs — and a handwritten paper chart.
Administrative demands on physicians’ time have increased in recent years. As a result, we spend more time on less productive activities. This further exacerbates the root problem: our calcified system has increased in complexity while maintaining the now-degraded and cumbersome technology of the late 1990s. I answer a pager. The laboratory IT system I consult was developed in the 1990s and seemingly never upgraded. A modern electronic health record has yet to materialize.
Did they really need to commission a costly study on why physician productivity has slumped? Did anyone ask a physician?
To further compound the broader problem, the practice of medicine has become more complex, scientifically as well as for demographic
A modern electronic health record has yet to materialize.
reasons. Our patients live longer, and with age come multiple, intersecting health conditions. The unique challenges presented by the socalled “grey tsunami” create complexities that there is no technological silver bullet for — but it prompts us to think about interventions that are within our power to implement.
As well, over the 10-year period covered by the study, the demographics and culture of medicine have changed for the better: In what was once a male-dominated field that prepared physicians to value work above all, such as through 36-hour sleepless shifts in residency, there are now far more young women and men in the medical profession who take time to pursue balance in their careers and in their family life. People tend to do higher quality work if they have more balance than if they are constantly “doing ” more to prove their commitment through quantifiable productivity.
While our salaries may now finally have come into line with those in the rest of Canada, government investments in the rest of the system have failed to show a similar progress. As a physician who has previously worked in British Columbia and Ontario, I can unequivocally state that the integration of those provincial systems as well as their design and level of technological adaptation and openness to innovation are significantly more advanced than Quebec’s. I witnessed a large number of my very best classmates and colleagues travel to greener pastures. Quebec-trained physicians, who are universally bilingual, have an easier time trying to leave the province than do physicians hoping to relocate to Quebec, given that the language barrier to entry is significant. In order to remain competitive, Quebec therefore needs to work harder than its neighbours to build robust systems at home.
There is absolutely no question that the government needs to invest in the health-care system. It should also invest in innovators who seek to improve care and reduce costs. It should remain competitive within the highly mobile physician labour markets to attract the best and brightest to care for our aging population. This might mean better salaries for doctors, but as the protest groups so rightly pointed out, this also means better pay for nurses and allied health professionals, health-care workers, upgraded technology, and by focusing on improving patient outcomes through a coalition of interventions.