The Boundaries of Physician Availability

August 8, 2010

I can’t get Wes Fisher’s post from yesterday out of my mind.  When the Doctor’s Always In talks about the creeping expectation of physician availability.  Newer, more efficient forms of media and communication have created the belief that doctors should be available nearly instantly and all the time.

It started with the pager and it’s evolved to real-time social media.

I’ve seen it too many times:  Physicians excited to please open the door to unlimited patient email only to see themselves shutting their families out at night as they answer questions – all for free.  And those physicians who suggest that emails should carry a fee are indicted for greed.

One problem is that health care is increasingly seen as a commodity without real costs.  Look at the recent attempt by legislators to cut Medicare 21% from providers who have already shaved their margins to practically nothing.

(Of course, the medical community’s lack of commitment to political action doesn’t help.)

When I speak I’m often asked why we don’t see more physicians in the social space.  Here’s why:  Outreach and engagement using new forms of social communication requires passion and energy.  Most physicians I know are too busy trying to keep their doors open to worry about messaging via social media.  The operation of a business in survival mode doesn’t make for cheery engagement.

Physician time is becoming increasingly devalued.  Once this issue is addressed, don’t be surprised if you see your primary care doctor launching a show on Ustream … after hours, of course.


rlbates August 8, 2010 at 8:54 am

This issue has been “chewing” on me and me on it for some time now, but I can’t seem to get it into a post as well said as yours or Dr. Wes’

DrV August 8, 2010 at 9:09 am

That’s why we’re here ; ) And I suspect that these issues are eating a lot of physicians, many of whom are afraid to speak up.

Rob August 8, 2010 at 9:12 am

We don’t accept email. The only reason we use technology in our practice is to increase efficiency. As a business, that efficiency has to also be a financial efficiency. If we see more patients, they are happy and we are better paid. If we spend less time on mundane tasks, we have more time to see patients. Until they come up with a way to pay for email, even some of us who are ahead of the curve in regards to technology will stay behind and wait. We just have to resist the voices that say it is greedy to not give away our services for free.

DrV August 8, 2010 at 11:05 am

Rob – Incredibly well said. You need to paste this and elaborate a little bit as a post. Or perhaps you have. Thank you.

Charlotte August 10, 2010 at 8:02 am

I definitely don’t want to use email with my clients. If you don’t have face to face meeting you can’t get all useful information.

Phil Baumann August 8, 2010 at 9:20 am

Time and attention are one of the biggest limiting agent for provider adoption of social media

Part of the problem right now, is that these media are evolving – both in features and user base. Physicians (most) can’t be all over the place online – given time considerations, they’ll likely have to decide which media are best for them and their patients.

These media weren’t designed with physicians and nurses in mind. That’s where opportunities to design software from the ground-up may accelerate adoption.


DrV August 8, 2010 at 11:01 am

I don’t think that it has to do so much with platform as it is the expectation that doctors will be working night and day communicating with patients….for free.

Brian August 8, 2010 at 11:11 am

Nice blog topic. My wife and I discussing this morning. I am a Pedimwho charges for after hour calls/text/web portal messages. I am always available but there is a fee. No complaints from patients. The number of calls etc since initiating policy decreased dramatically.

Greg Smith MD August 8, 2010 at 2:06 pm

Social media is serving multiple purposes for me at this point. First, I can stay in touch with IRL friends and family when I’m busy working, seeing pictures and comments about vacations, etc. FB does this quite well. My blog, even though it is a personal one at this point, has recently been an excellent way to disseminate information about medicine and psychiatry in easily digestible packets, stimulating good discussion. I look forward to doing more with it. Lastly, I have used Twitter in the past year as a way to network with other doctors and providers in a more casual, fun way, while mining little nuggets of gold in the form of blog posts, papers, studies, and other types of media. While I don’t use it so much to put out clinical data ( I see many other docs doing that) that that may be a possibility as time goes on. The possibilities are endless and exciting!

Bob Blount August 8, 2010 at 3:02 pm

Hey Dr.V,

Thanks for the post – nice insights. It’s refreshing to see others like @DoctorWes with similar post. As some of your readers have noted in their responses – they are trying out different channels for different reasons. Some personal and others taking it the professional path. Some charge while others don’t. In the end we all find our voice and join what works best. I encourage everyone to take a step – embrace the possibility and see where it takes you.

All the best,

Jackie Fox August 9, 2010 at 10:06 am

Just wanted to let you know that as a patient, I do not expect to contact my doctors by e-mail, friend them on Facebook, have them at my beck and call 24-7. I think it’s extremely important for doctors to set limits on your availability. I think “availability creep” is happening in society at large (at least in the U.S.) and I grit my teeth every time I create my “I’m on vacation and am not checking voice mail or e-mail” message, but I think it’s that much worse for you because what you do is so personal can be so intense. And let’s face it, some patients can be way too needy.

Wendy Sue Swanson, MD August 9, 2010 at 10:48 am

Thanks, Dr V
I agree with you. Asking to be paid for the work we do certainly shouldn’t be construed as greed. Outside of medicine, billable hours/being paid for what you do is standard.
As a primary care doctor (general pediatrician), it’s an amazing % of work I do for patients that is not reimbursed. It’s of course my job to provide a medical home for my patients, to coordinate care, to call specialists and advocate, and to call families back to review results, consults and worries. And it’s a privilege to do so. During and outside of regular business hours. But it is still work. When I’m doing it, I’m not at home enjoying my family…
We use EPIC in my clinic. It’s a fantastic EMR but not without fault (duh). It is an enormous time sink. Every time I pick up the phone to call a pt, every time I review a consult note, or review a lab, respond to an “e-chart” or “my-chart” e-mail, I have to open an encounter and jot it down. In a world with very limited time, EMRs can impede us; it steals our time.
I am just now learning how to work in social media, work in clinic, and raise children simultaneously. I certainly didn’t sign up to sacrifice all of my personal life when I went into medicine. Part of the reason I didn’t become a surgeon even though it is what I enjoyed the most as a med student.
As a woman in medicine and social media, I feel it is important for me to demonstrate a sustainable model. I witness many women (and men) do work for free. Often it’s expected. Just like teachers buying school supplies for their students when not provided…..
I had the idea of a blog years before I started to author one. Many MDs and administrators said I should do it for free. I waited until I was offered compensation. It’s a good fit for me now, but it is still work. I’m passionate about what I do but wouldn’t do it for free. I value my education, my unique skills, and my family far too much. I question why physicians would enter social media without knowing it would be compensated or improve efficiency elsewhere in their work.

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