Is the paper work really that bad?

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freedoctor17

freedoctor17

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I've been mainly interested in primary care and from all my shadowing that was the most enjoyable area for me. One thing I keep hearing terrible things about though is how bad the paper work is. Im trying to keep an open mind now (and I'll make sure to during medical school) but right now i can't see myself doing anything other than primary care.

My ideal position would be working in a smaller clinical setting where i could see patients without having to rush and actually have some time with each one. One of the doctors i shadowed did this and it seemed the most enjoyable to me. I don't really know much about the behind the scenes stuff though in terms of what he did in his office when not seeing patients and how much paper work there is. Can anyone who is actually familiar with this shed some light on it? I'm interested to hear from people with actual experience because the people I've been hearing from aren't really reliable sources, just other students. Also for me personally I don't care much about the money so I would take a lower paying position where I'd enjoy it more and have it closerto my ideal environment over higher paying one that isn't any day.

Tldr; I think I'd love some sort of primary care over anything else but I don't want to become miserable and hate it from getting bogged down with stacks of paper work.
 
Not a doctor, but I have been scribing for a family practitioner for several months now. I'm optimistic that EHRs will continue to improve and become more user friendly. Additionally, I'd like to believe the generation now going into medicine will have less trouble with the EHR since we grew up with computers. But again, this is a scribe's perspective. While I create the charts and help dictate ~80% of the inbox messages there's still much that I don't see, and likely don't understand the work behind generating each response or patient communication. So, scribes may continue to be needed in the future to avoid burnout. To end on a positive note, the cost of a scribe can typically be paid for by seeing 1-2 more patients a day without much more burden on the physician since the physicians no longer need to spend hours on charting after seeing patients.
 
gyngyn said:
Yes it is. It really, really is.
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Is the paperwork being that bad specific to primary care? Or do other areas have similar problems (for things like cardiology or pediatric cardiology?) Is it bad enough that you'd recommend people do something else Instead?
 
an576 said:
Not a doctor, but I have been scribing for a family practitioner for several months now. I'm optimistic that EHRs will continue to improve and become more user friendly. Additionally, I'd like to believe the generation now going into medicine will have less trouble with the EHR since we grew up with computers. But again, this is a scribe's perspective. While I create the charts and help dictate ~80% of the inbox messages there's still much that I don't see, and likely don't understand the work behind generating each response or patient communication. So, scribes may continue to be needed in the future to avoid burnout. To end on a positive note, the cost of a scribe can typically be paid for by seeing 1-2 more patients a day without much more burden on the physician since the physicians no longer need to spend hours on charting after seeing patients.
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I'm not too familiar with scribing. None if the doctors I shadowed had one. So as a scribe you take care of a lot of that paper work? Is the paper work just all the patient charts and things you mentioned? I always just hear "the paperwork sucks" and I have no idea what the paperwork even refers to exactly.
 
freedoctor17 said:
I always just hear "the paperwork sucks" and I have no idea what the paperwork even refers to exactly.
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Some examples: Paperwork includes filling out forms (like school physicals, sport forms, insurance), reading old paper medical records sent from a past doc, consultations, & ED or hospitalization records, new patient intake forms, completing CME forms (could also be electronic), reviewing messages from pharmacies or patients for refills, and patient queries, etc. This is in addition to Electronic Health Record completion, or personal phone calls to patients and insurance companies, and reviewing labs, which are mostly non-paperwork.
 
Catalystik said:
Some examples: Paperwork includes filling out forms (like school physicals, sport forms, insurance), reading old paper medical records sent from a past doc, consultations, & ED or hospitalization records, new patient intake forms, completing CME forms (could also be electronic), reviewing messages from pharmacies or patients for refills, and patient queries, etc. This is in addition to Electronic Health Record completion, or personal phone calls to patients and insurance companies, and reviewing labs, which are mostly non-paperwork.
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Thank you for the break down! That does sound like a lot.
 
Catalystik said:
The EHR is the worst of it. If you can hire a scribe to take over that part of the job, you won't need to grit your teeth so much.
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Alright thank you! That's reassuring to hear because every time i mention primary care there seems to be someone ready to discourage me from it.
 
Catalystik said:
The EHR is the worst of it. If you can hire a scribe to take over that part of the job, you won't need to grit your teeth so much.
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Better than a scribe is an MA. They only cost a little bit more, but they can generally act a little more independent.
 
samualjhatfield said:
Better than a scribe is an MA. They only cost a little bit more, but they can generally act a little more independent.
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With all due respect for MAs, they usually hire pre-med students with good understanding of basic sciences in order to be able to write up notes for the physician. This is really not something many MAs would be able to do.
 
Dang radiology just became a whole more appealing that it already is.
 
gonnif said:
One of my premed workshop presentations on "So you want to be a doctor" includes the following photos

This is my longtime primary care doc
View attachment 248712

This is my brother a long time podiatrist with just one side of his office
View attachment 248713 View attachment 248714
Click to expand...
This may seem like a silly set of questions but 1) how long ago were these pictures taken 2) how old are the physicians (longer on the job = more resistant to change?) and 3) Does the practice have a decent EHR?
 
allantois said:
With all due respect for MAs, they usually hire pre-med students with good understanding of basic sciences in order to be able to write up notes for the physician. This is really not something many MAs would be able to do.
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One of the doctors i shadowed had a medical assistant but the assistant just prepared the patient to see the doctor. They would do a few tests and get the results and give them to the doctor to analyze. The medical assistant also had no education after high school besides the minimal training required for the job (that told me this themselves) so i definitely see why they might not be able to help out as much in terms of the paperwork like a scribe. They did allow the doctor to interact more with the patients from what i could tell since the whole time he was in there he could focus on the issue at hand rather than taking care of all that initial stuff.
 
freedoctor17 said:
One of the doctors i shadowed had a medical assistant but the assistant just prepared the patient to see the doctor. They would do a few tests and get the results and give them to the doctor to analyze. The medical assistant also had no education after high school besides the minimal training required for the job (that told me this themselves) so i definitely see why they might not be able to help out as much in terms of the paperwork like a scribe. They did allow the doctor to interact more with the patients from what i could tell since the whole time he was in there he could focus on the issue at hand rather than taking care of all that initial stuff.
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I guess it may just be the urology clinic I work at, but the MAs place all orders, do all of the charting, call all patients, draw blood, assist during procedures (biopsies, vasectomies etc.), run CLIA waived testing...and other stuff I don’t even know.
 
doctorcocter said:
Dang radiology just became a whole more appealing that it already is.
Click to expand...

I avoided a lot of career options due to not wanting to sit at a computer all day lol. Shadowed a radiologist and not sure if i could ever do that. Maybe I'll change my mind once im there...

samualjhatfield said:
I guess it may just be the urology clinic I work at, but the MAs place all orders, do all of the charting, call all patients, draw blood, assist during procedures (biopsies, vasectomies etc.), run CLIA waived testing...and other stuff I don’t even know.
Click to expand...

Wow that sounds like they do a ton. I guess it depends on where you're at and the extent of the training they get. In my area I'm pretty sure almost anyone can do it with a high school diploma after getting a certificate in a year or less. They still seemed super helpful. The one with the doctor I shadowed was great. He'd go in and make that initial contact with the patients and start building their trust and just being very friendly while taking care of the initial tests and stuff. The doctor then came in and handled the rest including the computer stuff which didn't strike me as much paper work at the time since it seemed like he just added a few lines in. For all i know though he could have been doing a ton of it in his office while i was with the medical assistant prepping the patients.
 
freedoctor17 said:
I avoided a lot of career options due to not wanting to sit at a computer all day lol. Shadowed a radiologist and not sure if i could ever do that. Maybe I'll change my mind once im there...
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Some of the rads on the radiology forum even say that they were super bored on their rads rotation. It’s a lot different doing than watching. Plus you get out of the room to do procedures.
 
Matthew9Thirtyfive said:
Some of the rads on the radiology forum even say that they were super bored on their rads rotation. It’s a lot different doing than watching. Plus you get out of the room to do procedures.
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That's very true. Sitting and watching someone else make sense of a bunch of images that made no sense to me got boring pretty quickly haha. I'm sure it'll be much different doing it myself. I think my main issue was just the being in basement of a hospital mainly looking at images on a computer for hours straight. I've done a bit of programming and although i enjoyed it i didn't like sitting there for too long at once. I always had to get up and move around a bit and then come back. Who knows though, maybe I'll actually love it once I get there. I've heard plenty of people end up doing something they least expected.
 
I wish I understood what "a heavy amount of paperwork" is. Would this seem like a lot to me as a critical care RN? Is it even more than that or comparable? If there are any RN gone MD's, your insight would be great.
 
I've been an ED scribe intermittently for the past 5 years and even in this short time, I can say that paperwork is not only a huge pain, but also seems to be worsening. So many forms to fill out and useless buttons to click.

Having a scribe obviously makes it a lot easier for physicians but the doc still has to review all the documentation. Since the majority of scribes are pre-meds with little to no medical education, it's quite common for new scribes to make mistakes. I once DXed someone with hydronecrosis (death by water) instead of hydronephrosis :laugh:
 
Theyre "SUPPOSED" to review the documentation but it surprises me how many patients I've had that the NP obviously hadn't seen the patient in a long time (at least a month) and the physician signed off saying "I agree with this assessment", and they had obviously not viewed the patient either.

For instance "Patient remains in a vegetative state. Poor prognosis for recovery" documented on the very morning I went into the patients room and asked them what they wanted for breakfast, and they responded, and then asked me to pull them up...


This takes the cake though. MD note that says “fortunately the patients shouting was muffled by the bipap”
F520111E-563A-4B56-A440-665350E95FD4.png

Do they realize that people review these charts?
 
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stairway2seven said:
I've been an ED scribe intermittently for the past 5 years and even in this short time, I can say that paperwork is not only a huge pain, but also seems to be worsening. So many forms to fill out and useless buttons to click.

Having a scribe obviously makes it a lot easier for physicians but the doc still has to review all the documentation. Since the majority of scribes are pre-meds with little to no medical education, it's quite common for new scribes to make mistakes. I once DXed someone with hydronecrosis (death by water) instead of hydronephrosis :laugh:
Click to expand...

Wow this sounds rough. I never considered this side of being a physician. It's crazy how I felt so motivated to do well and get into medical school but now that it's become a reality I've been having every little doubt make me rethink things.

I've worked in an office position where all i did all day was fill out forms and file papers and i don't mind that. I can do tedious work but i can't imagine doing that on top of trying to see all my patients. Would hate to get overflowed with paper work that it ruins my time with patients. I just read an article about how bad it's gotten now a days. Maybe seeing less patients would improve things a bit?
 
Matthew9Thirtyfive said:
Without treatment, hydronephrosis can develop into hydronecrosis. Maybe they were trying to save time.
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Solution to all of the paperwork in medicine: Just diagnose all of your patients as dead and don’t treat them for anything.
 
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samualjhatfield said:
Solution to all of the paperwork in medicine: Just diagnose all of your patents as dead and don’t treat them for anything.
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“The art of medicine consists in amusing the patient while nature cures the disease.”
Voltaire
 
Matthew9Thirtyfive said:
“The art of medicine consists in amusing the patient while nature cures the disease.”
Voltaire
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i mean, to a large extent this does occur. Aside from surgeries, procedures and immunotherapy the physician just stabilized the patient until their body does its thing (this is a gross over simplification).
 
samualjhatfield said:
i mean, to a large extent this does occur. Aside from surgeries, procedures and immunotherapy the physician just stabilized the patient until their body does its thing (this is a gross over simplification).
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Even in surgery. There is definitely movement toward doing less in certain conditions. Apparently aggressive intervention isn’t always necessary or best. Go figure.
 
Established clinics with staff tend to greatly reduce the paper work load on physicians


Sent from my iPhone using SDN mobile
 
samualjhatfield said:
Also, if you are like me and willing to accept a 25-30% pay cut for ‘less work’ hospitalist/hospital affiliated clinic is where it’s at.
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Maybe that's why I didn't see much paper work while shadowing. I shadowed in a hospital affiliated clinic. Didn't realize that made a big difference. And i would take the 20 to 30 percent pay cut as well haha.
 
The doctors I work with are able to decrease their paperwork load using scribes and ARNPs.

However someone has to pay their salaries, so that can decrease income.

This is at a county hospital also - so they’re not making much money to begin with.
 
gonnif said:
One of my premed workshop presentations on "So you want to be a doctor" includes the following photos

This is my longtime primary care doc
View attachment 248712

This is my brother a long time podiatrist with just one side of his office
View attachment 248713 View attachment 248714
Click to expand...
Serious question: What's the purpose of all that paper? Because it looks like it's old and just sitting there in the office.
Is it all just a personal business record?
 
Scribes for our specialty (FM) have to be paid for by the provider, roughly 22-23k a year. I’m not going to do that extra work as I feel for me the benefit isn’t worth it.

I don’t fill out prior authorization forms, nursing does it.

I have to do maybe 1-2 peer to peer calls every few months for testing approval. I don’t order testing willy nilly. I have the patient complete the anticipated steps before imaging is needed. I take the time to document a detailed history, exam and plan so my documentation is often enough to get approval.

Epic has most of our standard forms available so data is imported and I rarely have to do more than sign.

My LPN will complete most forms for me so all I do is review and sign. She also pends a lot of orders I sign off on in addition to pending refills.

There is more paperwork than needed and it is one of my biggest complaints BUT it’s nowhere near what some docs make it out to be.
 
gonnif said:
Virtually all of it are patient medical records from the past day or two waiting to be updated and then entered into the system. I can call either doctor 2 or 3 hours after their last patient at 5-6pm and they will invariably finishing up reports, charts, forms from the day.
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That seems extremely inefficient. The docs I worked with had virtually zero physical paperwork because they just did everything directly into the EHR. We had some on the ship because Sailors still have a physical paper record that goes with them, so certain things are still put into that. But the docs would just print out something if it really needed to be entered into the paper record.

My wife’s OB’s office looked like a hoarder lived there. He refused to switch to an EHR and used paper charts for everyone. They piled up around his office like a manilla envelope forest.
 
Matthew9Thirtyfive said:
That seems extremely inefficient. The docs I worked with had virtually zero physical paperwork because they just did everything directly into the EHR. We had some on the ship because Sailors still have a physical paper record that goes with them, so certain things are still put into that. But the docs would just print out something if it really needed to be entered into the paper record.

My wife’s OB’s office looked like a hoarder lived there. He refused to switch to an EHR and used paper charts for everyone. They piled up around his office like a manilla envelope forest.
Click to expand...
When I worked LTAC it was all paper records. At my new job our paper charts are kept to a minimum. All paper records for our patients on the entire 33 bed unit are less thick than a textbook. EPIC makes things so much easier.
 
RNtoMD87 said:
When I worked LTAC it was all paper records. At my new job our paper charts are kept to a minimum. All paper records for our patients on the entire 33 bed unit are less thick than a textbook. EPIC makes things so much easier.
Click to expand...

My first hospital gig was paper and then got epic like 3 years into me working there. So much nicer.

AHLTA can be super frustrating though, like almost every website and/or computer program in the military.
 
gonnif said:
Virtually all of it are patient medical records from the past day or two waiting to be updated and then entered into the system. I can call either doctor 2 or 3 hours after their last patient at 5-6pm and they will invariably finishing up reports, charts, forms from the day.
Click to expand...
WHAT!? That's a lot hahah:pirate:
 
2-3 hours a day? No thanks. I will definitely be hiring an MA to handle all of that BS for me. I don't care about the money anyway.
 
What job doesn't require a lot of paperwork though? I've had a lot as a nurse, I had a lot as a cop, everything I can think of has a LOT of paperwork.
 
Matthew9Thirtyfive said:
Endless paperwork in the military. It's in almost every professional career.
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Man in the army I had to do paperwork on the condition of my equipment coming on and off shift, every contact I made with someone, every stop I made, had to write reports, sworn statements, inventories, etc. Had to do evaluations of my soldiers.

I think doctors who complain about paperwork never worked another job.
 
It's the paperwork and all the awful business side of medicine. I shadowed a pediatrician at a local community hospital, and a case came in where a child had a very, very serious problem. She said the hospital was not equipped to treat this and I saw her literally after her clinic ended basically calling and BEGGING other hospitals for a transfer because of insurance problems. Nothing is more heartbreaking than a sick child, and to see her use her free time to fight for a transfer was nice, but that issue should not arise, ever. She at one point took a weekend to fly to Boston to go personally go to Boston Childrens to fight in person for this kid.

Thankfully, eventually, he did get transferred. All of this non-sense is what leads to burnout in medicine.
 
Dr. Stalker said:
It's the paperwork and all the awful business side of medicine. I shadowed a pediatrician at a local community hospital, and a case came in where a child had a very, very serious problem. She said the hospital was not equipped to treat this and I saw her literally after her clinic ended basically calling and BEGGING other hospitals for a transfer because of insurance problems. Nothing is more heartbreaking than a sick child, and to see her use her free time to fight for a transfer was nice, but that issue should not arise, ever. She at one point took a weekend to fly to Boston to go personally go to Boston Childrens to fight in person for this kid.

Thankfully, eventually, he did get transferred. All of this non-sense is what leads to burnout in medicine.
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Do you know what type of insurance the patient had?
 
Bacchus said:
Do you know what type of insurance the patient had?
Click to expand...

It was a whole slew of issues; no insurance, lack of citizenship/not even permanent greencard holders. Parents got scared when the kid like started shivering/stopped eating, they go to the ED thinking its a quick fix, instead **** hit the fan. Happy the transfer worked, but it shouldn't be the case where attendings have to fly to hospitals to fight with admin for transfers. That isn't medicine. That's business. Unfortunately, the two are so intertwined now, it really hinders doctors from doing their jobs.
 
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