Why is an EHR-induced drop in doc demand generating so little interest?

I'm never surprised when readers comment on my editorials, either on the FierceEMR website or to me personally. I try to address timely, thought-provoking topics that give readers pause, as well as the opportunity to weigh in.

But I was a bit surprised when a news story I wrote last week about a study published in Health Affairs quickly generated comments. The study predicted, based on its analysis of electronic health record literature, that if just 30 percent of community-based physicians fully implemented health IT in their offices, the demand for physicians would decrease 4 to 9 percent. More care could be delegated from specialists to generalists, reducing the demand for specialists; correspondingly, more care could be delegated to non-physicians, reducing the demand of physicians. At the same time, doctors would gain efficiencies from workflow changes and consumer use of communication technology.

The researchers predicted that the numbers would more than double, causing the demand for physicians to decrease from 12 to 26 percent, if 70 percent of these physicians fully implemented their EHRs.

Evidently, the gains in efficiency claims in this study hit a nerve, with commenters strongly disagreeing with this conclusion. One commenter noted that an EHR lessen's productivity and that doctors "hate" EHRs; another called the study "propaganda in the worst form."

It's been well documented that implementing an EHR is likely to have an adverse effect on productivity and workflow, at least in the short term. It's also no secret that many physicians dislike their systems. So I rather expected some discussion regarding whether EHRs increased efficiencies.

But what I also was expecting--and haven't seen--was comments on the other conclusion of the study: that EHRs will cause significant physician job loss.

Usually any development potentially having a negative effect on physicians creates a lot of media and physician attention. We've all heard about how the SGR formula, new payment methodologies, and even the rise of retail clinics and the growing clout of nurse practitioners are hurting independent physicians. There's usually pushback from the vocal physician community and organized medicine.    

But this study says that the mere use of EHRs could cause a major drop in demand not only for specialists, but for all doctors. And so far, nary a peep.

Why? Is it because physicians, already overwhelmed by implementing EHRs and meeting Meaningful Use, have enough to worry about when it comes to their EHRs? Because the drop in demand isn't expected for several years? Because this aspect of the study garnered less publicity? Because most physicians believe that this won't affect them, it will affect the other guy?

Now, the demand for personnel in all industries, including the healthcare industry, evolves over time. The need for health IT personnel is booming; we need fewer typewriter repairmen.

This study's conclusion is one that needs to be taken seriously. This change can have widespread ramifications.

If EHRs lower the need for physicians, then physicians--and other stakeholders--need to assess this issue, prepare for such a change, and ensure that the reduction in demand doesn't disproportionately affect patients and areas already lacking this needed resource. - Marla (@MarlaHirsch @FierceHealthIT)

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