Burning Down The Medical Village To Save It: The Folly Of Big Data In Medicine

Rena Xu's recent piece in The Atlantic on physician burnout is mostly interesting for its between-the-lines reporting. Yes, Big Data (i.e. medical coding) is driving a lot of physician burnout:

Regulations governing the use of electronic medical records (EMRs), first introduced in the Health Information Technology for Economic and Clinical Health (HITECH) Act in 2009, have gotten more and more demanding, while expanded insurance coverage from the Affordable Care Act may have contributed to an uptrend in patient volume at many health centers. These changes are taking a toll on physicians: There’s some evidence that the administrative burden of medicine—and with it, the proportion of burned-out doctors—is on the rise. A study published last year in Health Affairs reported that from 2011 to 2014, physicians spent progressively more time on “desktop medicine” and less on face-to-face patient care. Another study found that the percentage of physicians reporting burnout increased over the same period; by 2014, more than half said they were affected.

But won't we need ever-more new physicians to deal with the aging US population? Yes, we will, but —

A quarter of U.S. physicians are expected to retire over the next decade, while the number of older Americans, who tend to need more health care, is expected to double by 2040. While it might be tempting to point to the historically competitive rates of medical-school admissions as proof that the talent pipeline for physicians won’t run dry, there is no guarantee. Last year, for the first time in at least a decade, the volume of medical school applications dropped—by nearly 14,000, according to data from the Association of American Medical Colleges. By the association’s projections, we may be short 100,000 physicians or more by 2030.

And this despite modest, recent upticks in new physicians, even despite Medicare's meddling in internship slots. In addition, the article cites the "Resident Physician Shortage Reduction Act ... [which] would add 15,000 residency spots over a five-year period." That's a 1.6% increase vs. the 2014 physician population of 916,264, but nothing compared to the gaping hole implied by 100,000 missing doctors. Mandated medical coding — the raw material of Big Data in medicine — contributes to a physician burnout we can scarcely afford.

But this kind of insanity is to be expected. The people who imagine they are helping very frequently do not subject themselves to the consequences of their "help" (viz., Jonathan Gruber, who is not a doctor). The meretricious belief that big data will somehow "bend the cost curve" is deeply embedded, including, especially, in service providers with something to sell. There are costs to acquiring that data, and that cost is, more administrative overhead (emboldening mine):

...[D]octors are most valuable when doing what they were trained to do—treating patients. Likewise, non-physicians are better suited to accomplish many of the tasks that currently fall upon physicians. The use of medical scribes during clinic visits, for instance, not only frees doctors to talk with their patients but also potentially yields better documentation. A study published last month in the World Journal of Urology reported that the introduction of scribes in a urology practice significantly increased physician efficiency, work satisfaction, and revenue.

And who pays for that increased revenue? Ultimately, it's the patients, of course, or the government (taxpayers) if it's Medicare/Medicaid.