To the editor:

To respond to my colleague Tom McLaughlin's column: There is not a current critical shortage of physicians and nurses but rather a critical mal-deployment of physicians and nurses in the United States. There are two major causes for this: the elimination of the clinical support team and the exponential increase in the complexity of clinical documentation.

In the first case, physicians and nurses used to have licensed practical nurses, nursing and medical assistants, technologists and clerical specialists perform all of the routine tasks so that they could be freed up to make clinical decisions. Unfortunately, some misguided committee in California came up with nursing staffing ratios (e.g. 5:1) which spread throughout the country and eliminated the team, leaving physicians and nurses to perform all of the support tasks along with their regular clinical duties.

In the second case, documentation of patient care used to be simple. If someone had heart failure, you wrote "heart failure" and got paid. Today, you need to write an exposition with dozens of required documentation elements if you want to get paid. This requires clinical documentation and coding expertise which physicians and nurses don't have. Unfortunately, physicians (according to the AMA) spend 50 percent of their time and nurses (according to the ANA) 70 percent of their time performing documentation functions that they do not do well because they lack coding knowledge. (They also don't like doing it.)

Wise healthcare organizations throughout the country are working on rectifying this situation by bringing back the clinical team and hiring clinical scribes (who are coders) to do the documentation leaving physicians and nurses to do what they do best: taking care of patients.

Fix these two issues and there will be physicians and nurses to spare.

Jon Burroughs


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