Time Capsule: Community Physicians and Technology: Think Convenience Store Owner, Not Society-Minded Scientist

I wrote weekly editorials for a boutique industry newsletter for several years, anxious for both audience and income. I learned a lot about coming up with ideas for the weekly grind, trying to be simultaneously opinionated and entertaining in a few hundred words, and not sleeping much because I was working all the time. They’re fun to read as a look back at what was important then (and often still important now).

I wrote this piece in February 2008.

Community Physicians and Technology: Think Convenience Store Owner, Not Society-Minded Scientist
By Mr. HIStalk

I have had the magic revelation. I know now why we healthcare IT people can’t figure out the seemingly puzzling behavior of small-practice doctors when it comes to technology adoption.

Here it is. Once they hang out a shingle, they’re no longer society-minded scientists. They’re small business owners.

The next time someone talks about physician practices, replace that term with “convenience store owner.” They’re on every corner, they compete vigorously for business, they watch expenses with an eagle eye, and they pay themselves only after everybody else gets paid. And unlike convenience store owners, they have to deal with insurance companies who tell them what they’ll get paid and hammer them with a mass of ever-changing regulations.

They’re also going to look at IT a lot differently than doctors in hospitals. Or especially, than hospitals themselves. Any money they spend on IT comes out of their own pockets. Any help they need doesn’t come from the friendly IT department — they have to find someone and pay high rates for even simple tasks, like installing a PC or figuring out connectivity problems.

Technology cheerleaders get frustrated that docs don’t just buy systems and get with the program so everybody can benefit. The problem is that everybody doesn’t benefit. Doc has just made a donation to insurance companies, patients, and hospitals who all appreciate the boost in their well-being from his or her investment. That doesn’t even include the extra time required to maintain electronic documentation, which always takes longer than scribbling. Physicians have just one thing to sell: time. They protect it strenuously, as they should.

We hospital types forget that 90 percent of a general practitioner’s time and even more of his or her income comes from their small business. Seeing patients in the hospital is a cost of doing business, not the day’s focus. While the hospital folks are going to meetings and delivering care as part of a big team, Doc’s out there on the front lines taking all comers, armed only with a few minimally trained assistants and whatever’s in his or her head, trying to improve health and provide a positive customer experience in an average of six minutes per visit.

The people they deal with in hospitals have, for the most part, never run a small business. They’ve always worked for someone else. The world looks a lot different when the only employer who’ll take care of you is you.

From an economic standpoint, doctors are paid to work. If we’ve got some kind of beef about excessive use of diagnostic procedures or esoteric treatments, we need to stop paying for them. That convenience store owner will sell you cigarettes and beer that are bad for you because (a) you want them, and (b) it adds to their bottom line. There’s a word for those civic-minded C-stores that stop selling them on principal: defunct.

Doctors are pretty much stuck in the small business model. The problem is that we’re expecting them to hold hands and join the choir even though they’re struggling to keep the doors open given rampant competition, reduced payments, and a fickle market.

I’m making a point to think twice before ripping doctors for not jumping all over e-prescribing, pay for performance, or interoperability. Unless you’ve got a rock-solid argument that would convince a convenience store owner, you’re wasting your time.