Maybe there's a reason why meaningful use seems to favor primary care

Last week, we ran a story about how the American Academy of Orthopaedic Surgeons believes the stage 1 standards for meaningful use of EMRs don't really apply to its specialty.

That item drew comments from two people fairly well known by the FierceEMR audience. SRSsoft CEO Evan Steele and orthopedic nurse technician Barb "Bobcat" Guster. Both cheered the AAOS position and explained in their own ways why they think the federal EMR incentive program is skewed toward primary care.

I certainly see where they are coming from, but let's play devil's advocate for a moment.

It's no secret that primary care is in crisis in this country. The same goes for rural medicine. With new physicians coming out of medical school with ever-increasing debt loads, it makes more sense to want to pay off their massive loans as quickly as possible--and the financial rewards of certain specialties far outstrip those for primary care. Likewise, our skewed system encourages volume, so it only makes sense that more physicians would opt for densely populated areas.

The thing is, young doctors tend to be tech-savvy. Many learned how to use EMRs in med school or residency and couldn't imagine practicing without one. A recent story in the Washington Post highlighted just how unattractive primary care and rural practice can be for the newest generation of physicians.

"I grew up in the age of electronic medical records," 33-year-old Dr. Sarah Carricaburu, who signed a three-year contract with the National Health Services Corps to be the only full-time physician at a clinic in remote Esmont, Va., told the Post. "Coming here was like stepping back in time. I would like to stay in a community healthcare setting, but here I didn't feel like I had the resources to do my job. You're cut off."

According to the story, Carricaburu was just one of two family practitioners in her graduating class at Northwestern University's Feinberg School of Medicine. She took the rural post mostly because federal aid is providing her with $50,000 toward retiring her $200,000 in education debt. Though she lives in the quaint college town of Charlottesville, Va., it's a 23-mile commute over winding, country roads to her job, in a spot where her iPhone doesn't work and her office computer only has dial-up Internet service.

While the two older, part-time physicians at the clinic have set up Carricaburu on dates in hopes of improving her personal life, they are reluctant to take the time to learn how to use the EMR that might keep Carricaburu around after her contract expires in a year. If she bolts, the practice might have to start turning away patients again, and the poor state of rural health will self-perpetuate.

Perhaps EMRs could break that cycle. - Neil