The True Cost of Charting

I was honored to be invited back into Dr. Sunny Smith's Empowering Women Physicians (EWP) Coaching Program in January 2023 doing what I love to do in my role as The Charting Coach - helping the attendees get home with today's work done. My guest coach appearance was announced with an email that was quite thought-provoking, so I thought I would share a revised edition with you.

When Dr. Sunny Smith sent this email out in the fall of 2022 there were literally immediate responses that said things like "You should go speak to congress".

Take a read for yourself below 😊

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It's something I think all physicians need to know and think about the history, the context, the why, the cost to you, and how other similar professions would never be asked to do this, nor would they comply.

It's about one of the biggest pains of modern medicine *****CHARTING*****
It's compelling and when you hear the numbers, you may want to tell a friend. Or your boss. Or do something about it yourself.

A little US economic history for context really quickly - Following the 2008 economic crash, the American Recovery and Reinvestment Act of 2009 was passed including many provisions in health care including the  Health Information Technology for Economic Clinical Health Act (HITECH Act) which led to meaningful use and enabled tech companies to rush into the Electronic Health Care record space rapidly with tens of billions of dollars at stake. 

This resulted in EHRs being rolled out in quite a hurried fashion and in hindsight...let's just say, less than ideal.

Who pays the price? WE DO. The physicians do.  We become the world's most expensive data entry clerks. We literally spend more time facing a screen than facing a patient. 

AT WHAT COST? The toll on our own well-being is immeasurable in many ways. The literature states burnout costs each organization at least $7500 per physician and leads to attrition, and it costs an organization up to $1 Million to replace one physician. 

But how about YOU? 
Your own personal time and money and lost income.  
Not even counting your mental health (which is priceless).

Let's do some back-of-the-napkin math.
For some really conservative math, we'll use me (Dr. Sunny Smith) as an example.  
I was an academic family physician running a free clinic, making a $207,000 per year salary as a Full Professor after 15 years in primary care. Most doctors make well over this, but we'll use me as an example.

We'll estimate I spent 10 hours a week outside of clinic time when I was at home with my family, nights and weekends (aka pajama time) doing administrative work.  

That's about $100 an hour x 10 hours a week 
=costing me $1000 of work EACH WEEK I was doing for free. 
(And I was a low-paid specialty)

Now, if I had WANTED to work an extra ten hours a week, I could do so for sure. I had moonlighted before. But those ten hours I worked on purpose when I was moonlighting actually EARNED an extra $1000/week or more. 

That's about $50,000 a year a typical primary care doc is volunteering outside of clinic time. Every year. If they do 10 hours a week admin outside of patient care. Much more if you are a higher-paying specialist.

Over the course of a career (which would be well over 20 years), it's easy to see that's well over a million dollars of lost income if you wanted to actually work an extra 10 hours a week and be paid for it. Not even counting compound interest. 

With compound interest, that pajama time volunteerism adds up to multi-million dollars of lost wages over our careers PER PHYSICIAN. 

Not to mention women physicians answer 24% more patient requests in the EHR and another 20+% staff requests in the EHR. When we (women physicians) are already earning $2 Million less (over our careers) than our white male peers.

THE SYSTEM HAS TO CHANGE. It HAS TO. This is unsustainable. The mental health load can not as easily be quantified but is making physicians miserable and driving people out of medicine. Over 100,000 physicians have recently left medicine in the US. That's about 10% of the total physician workforce.

Meanwhile - there is something you can do to take control of the current system.

Dr. Sarah Smith is the BEST charting coach I know. I was skeptical at first. I was always behind in my charts. But round after round (in the EWP program), every time, we see real women physicians of every specialty get this under control.

How? We are very privileged that Dr. Sarah Smith comes into EWP to give us her best tips and tricks and secrets that she has learned by coaching several hundred physicians to chart better, faster, and close their charts SAME DAY. See a patient, close a chart, see a patient, close a chart. No charting on nights and weekends.  

Even if the physicians were on probation for being so behind on charts, even if they have difficulties with their hands, never used EHRs in the past, are in the ED, rural primary care, hospitalists, ID, oncology, and subspecialty care.

For me (Dr. Sunny Smith), as someone who chronically had about 100 open charts in my inbox on any given day (including the day I broke both of my arms in Tahiti and then couldn't chart for months after) - She's a bit of a miracle worker.

Think it's too good to be true?
If you saw our orientation calls in EWP, you would have seen the OB Gyn who spontaneously said that her session with Sarah the first week of EWP was "worth the whole investment in the program" as she went back to the clinic and restructured her clinical day and approach with her MA and HAS NOT CHARTED AT HOME SINCE. **Gasp** Seems too good to be true, right? When I questioned and said - WHAT? NONE SINCE.  She added even her OWN HUSBAND can't believe it and kept saying "don't you have any charts to do?"  and she answers "NO". I mean.... come on. Pretty amazing. She didn't change the number of patients, her clinic schedule, her OR schedule, or her EHR. She just DECIDED to apply what she learned and take action. 

Tell anyone who is suffering with their charting to check Dr. Sarah Smith out, she is asked to speak nationally across the US and Canada about this.  

We don't ask the judge to be the court reporter, but just imagine if we treated them like we treat doctors and asked them to go home and document what they saw in the courtroom from their pajamas at night. Pretty ridiculous right? Then why has our culture of medicine normalized this for us?

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Thank you Dr. Sunny Smith for letting me share this information and for being a supporter of this work 😍, those were some pretty amazing testimonials!

Do you find this true for yourself - that charting in the evening and on weekends has a financial cost to you?

I have previously blogged about Physicians under-earning when we are working outside of clinical hours. Our time is precious - and this is a reminder that our time also has a dollar figure.

I would be delighted if you would join me at the free live masterclass coming up on January 28th, that's Saturday morning bright and early. We will cover the four steps to get you home with today's work done and if you register but cannot come live then we will email you a replay. I leave time for questions and I would love to get to know you and hear the things you struggle with during your clinical day. To register follow this link www.chartingcoach.ca/masterclass-registration

Have a fabulous week and keep striving toward sustainable clinical medicine your way!