Tuesday, January 29, 2019

Stretched to the Limit

Editor's Note: The following article is the first of six stories TMA's Healthy Vision 2025 advocacy plan, highlighting TMA's priorities for the 86th Legislative session. This post details how Lisa Ehrlich, MD, reinvented her medical practice to reduce physician burnout and return more focus on her patients.

There came a moment when all the clicking on boxes, filling out forms, and waiting on hold was just too much for Houston internist Lisa Ehrlich, MD. The time and energy spent on all of these seemingly endless tasks meant she could not give nearly enough to her patients.

And after 19 years in private practice, with insurance companies and the government expecting her to care for 3,000-plus patients, she was burning out.

“I was really tired, exhausted,” Dr. Ehrlich said. “I did not want to go to work in the morning. … I was stretched to the limit.”

On the outside, her practice looked like the model of success. She earned recognition from the Health Care Incentives Improvement Institute for diabetes care, for asthma care, and for using health information technology. Vitals.com — an online physician rating system — regularly gave her its Patient’s Choice Award and Compassionate Doctor Recognition.

Dr. Ehrlich and her partner employed seven billing and clinical care staff, and could have used even more help. Meanwhile, payments were diminishing and electronic health records costs were exploding. “We were drowning,” she said.

“I was forced to begin limiting the time I spent with my patients and offload communications to my staff. I was spending more than half of my time on paperwork, haggling with insurance, and regulatory box checking.”

She worried that quality-improvement programs were doing little to keep her patients healthier or to hold costs down. She chafed at the forces that transformed the medical record — her patients’ charts — from a clinical instrument into a tool to satisfy third-party payers and government regulators. She seethed at wasting time with prior authorization phone calls that took her away from her patients.

“We were, and still are, in a constant exercise that’s really designed to save the middleman money,” Dr. Ehrlich said. “It’s not for the care of the patient, and it’s not actually really saving money. It’s a tax on our practices. It’s a tax on us.”


Houston internist Lisa Erhlich, MD, shares how she reinvented her medical practice to reduce physician burnout and return more focus on her patients.


In response, she staged her own revolution. Twenty-five years after graduating medical school, she eschewed joining forces with a big hospital system and instead reinvented her practice. Even though the personalized care model she implemented means she is accessible to her patients nearly 24/7, Dr. Ehrlich says she is happier — and saner. She’s still clicking and haggling, but on behalf of only 600 patients, all of whom she knows well.

“This arrangement has put the joy of practicing medicine and really caring for patients back in my life,” she said.

Her patients have a deeper, personal relationship with their very own physician, who is almost always on call. “This can be life-saving,” Dr. Ehrlich said, describing one case where her intimate knowledge of a patient’s medical history led her to arrange immediate treatment for necrotizing fasciitis — more commonly known as “flesh-eating bacteria.”

Or there’s the long-time patient who called her with unusual chest pains on Labor Day weekend. With his normal lab results and electrocardiogram, Dr. Ehrlich says, most emergency rooms would have released him with no further work-up.

“But I just did not like the way he looked.”

Acting on instinct, she persuaded a cardiologist to perform an angiogram.

“He ended up having a 95-percent blockage of the left main artery, which we call the ‘widow maker,’” she said. “He was admitted immediately for bypass surgery and is a healthy survivor. In my old model, I would have had a 25-percent chance of being on call that day.”

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