Recently, a political piece in the Washington Post entitled “Why Doctors Quit,” focused primarily on the ills of electronic medical records (EMR). While the intent was to criticize the Affordable Care Act, which penalizes doctors who don’t use EMR, most physicians (Republican or Democrat) indeed have many complaints about EMRs: They are difficult to use, take time away from patient care and are mostly used for billing and not improving care.

Yet, the overall question of why physicians leave practices early or decide to stay is worth answering, as EMRs are only one aspect of dissatisfaction. According to a recent Medscape survey of more than 19,000 physicians regarding compensation in 2015, a third of physicians would not choose medicine if they had it to do all over again and more than half would not select their current specialty.

Dealing with insurance companies is probably a bigger burden than EMRs, especially the hassle of medication prior authorizations. In the Medscape survey, 68% of physicians reported spending 10 hours or more weekly on paperwork and administration. Other annoyances include decreased reimbursement, working in an environment in which every patient interaction is a potential lawsuit and loss of autonomy.

However, looking at the factors that cause the greatest satisfaction—and the likely reasons that many remain in practice—are equally important. According to the Medscape survey, relationships with patients and being good at their job are the top two sources of satisfaction, and far outweigh other factors, which makes sense since wanting to help patients is a core value.

The pharmaceutical industry should know four key things causing both responses.

1. Work with EMR vendors. Despite physicians’ dislike, EMRs are here to stay. Pharma should work with EMR vendors to ensure their products are easy to prescribe—especially the non-pill products that present ePrescribing challenges.

2. Help with formulary issues. While pharma’s first priority is getting a product on formulary, the real issue for physicians is prior authorizations and step edits. Coupons have been extremely helpful in reducing patient costs but don’t help with these annoyances. Some companies are now clever and work directly with retail pharmacies or contract with private mail order pharmacies to bypass the insurer altogether.

3. Respect interest, not just time. Although a 30-second version of marketing’s “three key messages,” for instance may help pharma sales representatives show respect for a physician’s time, this may not address the physician’s interest for what’s best for their patient. Since physicians gain satisfaction by doing a good job, promotional messages should help them achieve this goal.

4. Assist with relationship building. The other key element of physician satisfaction is relationship building. Describing why or how to take a prescription is one conversation that can build rapport. Pharma should provide both hard copy and digital media that assist physicians with these discussions. However, unbranded material is often so general that it is not helpful—and the fair balance in branded patient instructions can often lead to confusion.

  • Matthew Mintz, M.D.

    Matthew Mintz, MD, FACP, is Associate Professor of Medicine and Director, Premier Access and Executive Services at The George Washington University School of Medicine in Washington, DC. Visit his blog at www.drmintz.com.

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