> Another study found US clinicians write 4x longer notes
I wasn't aware of this, but as the spouse of a medical provider I know that most US providers are burdened with an ever-present worry about malpractice.
This. So much this. In residency we are taught “document, document, document” and “this is a medical legal document” which leads to defensive medicine. Another point of why we spend more time documenting is billing. Coders/billers continue to come back and asking us to add more details about a diagnosis. More details = more charges to bill or up level. So the next progress note or office visit, I go back to add more. More time is spent fighting the notes. Terrible EMRs that destroy notes is one that leads to more time spent as well. Looking at you Allscripts (aka Allshits in my office). Overall it’s a sad state of medicine in the USA, which is terrible as when I was younger the whole point of medicine for me was to help people and focus on the patient and the issues that are ailing them. Now, patients are still important to me but it’s a race to the bottom trying to document while in seeing the patients so I can go home without paperwork and live my life. I got bills to pay, a 6 figure student loan that will take me another decade to pay off. At some point, it’s all going break down. Few of us are doing the concierge direct primary care model to avoid all this which will unfortunately lead to more health disparities and inequalities.
Direct primary care (DPC)/concierge is mostly cash only so you document as you see fit and are not held to the rules of having to use an EHR/EMR. Many of those who do this model are on paper as they are more “old school” at this time. Younger physicians would document more just because they are taught this in residency but some of the malpractice lawyers we had presentations with often said document well but don’t over do it as over-documentation can mean more things to be picked at when your are being sued. That said, over documentation helps billers code for every single thing they can and want more over documentation. So in general, they will hassle you to over-document. They will send you messages in the EMR, send you emails, even sometimes use the pager service until you update your note.
I think the legal worries, when it’s in concierge medicine, are over blown because at that point you are seeing a physician that is doing more quality than quantity to make ends meet. You don’t need to document to appease the biller but document enough to know what you did and so that you could share your chart notes with other providers in case the patient ever moved to another provider or (super rare) if they were admitted into the hospital and they needed some documentation for whatever reason. DPC, you are the boss and control how many patients you want to take on. In general private practice, you are at the mercy of the hospital system, payers, etc etc and are pulled in 7 different ways to make money which only benefits them and not the physician. Even then, with primary care, you are told you are a “loss leader” since we aren’t specialists and generally dumped on in the medical field.
In “private” practice, you need to see 20-30/day patients to make your salary (break even) without bonuses within a hospital/health system. That means about 400-450 patients per month. Major payers limit you to 3,000 patients under your care overall.
Studies show that 1,000:1 should be the max patient:physician ratio but many of us are around the 2-3k mark. In a true concierge medicine/direct primacy care model, since it’s mostly cash/subscription model, most of physicians average 300-500 patient panel per year which is about 4-6 patients a day. If you want to see more and make more on the side, see 400-600 patients. Are you an older doc who wants to practice but not see many patients, see 2-4 patients a day, 1-2 days a week and cover costs and still make a comfortable living.
Like I said, something is going break in the medical system and it’s only a matter of time. When it does, the healthcare disparities and inequalities will really become more apparent. Hospital systems/admins/insurance companies are now leaning on mid-levels like NPs/PAs as a bandaid to the issues of patient access but what will happen when you burn them out too?
/rant
Tldr, concierge medicine, your own boss, do whatever you want with your charting. You can chart 5 words or 5 paragraphs. Most physicians will chart enough to document well for medical and legal reasons and not have to worry about billers muddying the waters to over-document. Quality time with patients = less legal risk.
I wasn't aware of this, but as the spouse of a medical provider I know that most US providers are burdened with an ever-present worry about malpractice.