Bruce Feinberg, DO: We can get into what IDNs can do better and maybe some things they don’t do as well. It seems like it may be off subject, but physician burnout is getting to be a really serious issue, particularly in oncology. It’s not easy, as those of us who’ve done this, to basically spend every day telling people they’re going to die. As a result of all the additional stressors that happen today, when we look at this movement of community oncology into IDNs [integrated delivery networks], it raises that question: How much of that was really financially driven by 340B and hospitals wanting those? How much was driven by practices? Certainly, in those 3-to-5-person practices where the burnout factor was so high, they just wanted to get that burden on somebody else’s shoulders. I’m curious what you think.
Mark S. Soberman, MD, MBA, FACS: The burnout factor, interestingly, is not just a private practice phenomenon. You see it in the IDNs. It’s just the emotional toll that being a cancer care provider takes. EHRs [electronic health records] are a significant piece of this. The tasks that we have put on our providers are significant. Improving workflow, optimizing the time that providers spend with patients, taking tasks off their table—these are all things that we need to do. Getting that joy of practice back in is a real challenge.
In our work at ACCC [Association of Community Cancer Centers], our president has a theme every year. This year our president, Tom Gallo, has burnout and resilience in cancer care providers as his theme. We recently had some meetings about that. It’s a big problem. It’s a problem for primary care doctors; it’s a problem for oncology doctors. What are the estimates? Forty percent of your time as a provider is spent with the EHR, clerical tasks, and all these other things that are not face-to-face patient time or the things that you enjoy doing and that really create value. It’s a problem throughout medicine.
Michael Kolodziej, MD: It’s all the EHR. I think the statement that was made a little while ago that there’s a generational element here, which is that we are from an entrepreneurial generation and the newer graduates are less entrepreneurial, is absolutely a big piece of it. At some point, you just get tired of dealing with that, so the older doctors are happy to turn that over to the hospital system. But I think—as my wife, who’s a practicing oncologist, reminds me every day, as if I have something to do with it—EHRs are the problem. They really are a huge issue.
Bruce Feinberg, DO: You could argue that it’s prior authorizations, but a lot of those kinds of barriers to providing care and the challenges to autonomy have been there and haven’t changed that much. They can be taken off your plate because you can hire back-office people.
Mark S. Soberman, MD, MBA, FACS: Absolutely.
Bruce Feinberg, DO: But the 1 thing you can’t remove yourself from is having to work with the EHR. That is just a responsibility that you can’t delegate. You can have a scribe, but to some degree, it falls on the doctor.