Death. That is a tough word to use for CME. But the Kenmore Mercy Hospital Continuing Medical Education Program ended (or died) with the last of the March 2018 presentations after running twice a month continuously in the same format since 1990. Over 28 years with over 670 speakers with many of them memorable presentations.
Who cares? Obviously no one does, as the termination was because there were dwindling audiences to the point where there was more effort from the speakers and the Kenmore Staff to maintain it then there was benefit to participants. Probably no one will notice it is gone, and few people will alter their schedules as a consequence of this, although I confess that I attended almost all of them and I learned a lot from doing it. But maybe nobody else but me will pay much note.
In Internal Medicine we do postmortem analysis, and this program has earned a post-hoc search for the murder weapon. Time to learn from this experience and see why a cornerstone of improving quality no longer factored into what we do every day. First, let’s exonerate the innocent.
Did the nature of CME or the need for CME change over the years? No, CME formats and availability are more or less the same as they have been for decades. NYS and insurers still require regular CME. And the Catholic health System has if anything been much more forceful in making sure that CME is documented at the time of recertification of privileges, or staff members can’t get their 2 year recertification. Innocent.
Maybe there are fewer physicians and NPP’s on site, so there is no one to attend. Clearly not the case. The hospital remains as full as ever with a large number of primary, specialist, and subspecialist physicians, NP’s and PA’s who populate the building and care for our patients. The absolute number may be down some, but due to the hospitalist model there are many more total hours in the hospital than our historical numbers, so there are many more opportunities to participate.
Could it be that our current clinicians are smarter and do not need any education in their performance of their responsibilities? I won’t even touch that question – you can each individually contemplate its relevance, and we will move on. However, what is clear is that hospitalized patients are sicker, more complicated, and infinitely more complex. Much more skill – not less – is needed to care for them well, efficiently, and with compassion.
Who/what is responsible? I would postulate the answer may be TIME. Our current clinicians are in the hospitals much more due to the advent of hospitalist model, so there seems to be a new luxury opportunity to attend on-site, high quality, free CME that never existed when everyone was a “splitter” – rushing from early hospital rounds to the office to deal with a whole day’s worth of problems there. And those were typically very long hours. But our 2018 providers say they just have no time. Despite the seeming paradox, that is the situation. They even participate less in meetings, committees, and hospital affairs than their predecessors citing the same concern – not enough time.
Where did the time go? Perhaps now we are getting closer to the true killer. And this one seems to be a serial murderer because it has done this before and keeps on killing. Our friend, the electronic health record (EHR), appears to have a smoking gun in its hands. Innumerable studies now recapitulate our personal experience – the EHR sucks the life, time and energy out of clinicians’ days. Strong words, but no one reading this who uses an EHR will disagree. On the floors, you see doctors (and our nurses) sitting at computer terminals endlessly – much more than time in patient rooms. Usage studies show that office hours do not end when physicians go home. The recent article “Date Night with the EHR” quantified how much of our evening and weekend hours are spent on the computer. Most of us already knew this intuitively – although most of our spouses figured it out before we did.
Can we change this ourselves? Or should we not even care since this is “progress” and the new, better way? Any process that turns us into typists instead of doctors can never truly be our career workflow destination, even though that is where we find ourselves.
It seems we have 2 directions to pursue. First, we all have to demand better EHR’s. They won’t be there right away, but every provider needs to speak out about what it wrong and be willing to engage with the vendors to fix it. Even as CHS looks at replacing our hospital EHR it will take dedicated physicians to hold any vendor’s proverbial feet to the fire to demand a functional product. Same applies in our offices.
And we need to find workarounds for our exiting processes. Whether it is scribing, voice dictation, or other processes (not cloning!) we need to study and implement ways to get us away from the terminals.
So CME at Kenmore exists no more. But looking for the root causes may provide some insights into how the computer revolution is changing healthcare in some unexpected ways. Call this one guilty as charged for today.
