A Tuesday in the Clinic
Let me give you an example. Last Tuesday, I saw 22 patients. I spent 14 hours at the clinic. Four of those hours were spent on patient care. The other ten? Compliance documentation, insurance pre-authorizations, electronic health record entries that nobody will ever read, and a mandatory training module on workplace sensitivity that had nothing to do with medicine.
The paperwork takes longer than the treatment.
In practice, this means a patient with a sinus infection — a diagnosis I can make in thirty seconds — requires forty-five minutes of my time. Not because the medicine is complicated. Because the documentation is.
The Cost of Compliance
I own a rural clinic in Montana. Five employees, including me. Last year, I calculated that we spend approximately $127,000 annually on regulatory compliance. That's staff time for documentation, software licenses for mandated reporting systems, continuing education for requirements that change quarterly, and legal consultation for rules that are written in a language no medical professional speaks.
Let me tell you about a patient I saw this week. Elderly woman, diabetic, needed an insulin pump adjustment. The clinical decision took me three minutes. The prior authorization from her insurance company took eleven days. Eleven days of phone calls, faxes (yes, faxes — healthcare is the last industry that still uses them), and automated hold music.
Washington has never changed a bedpan. But they've written 180,000 pages of regulations telling me how to change one.
What the Mandate Machine Produces
Here's what that looks like in a real clinic: I spend more time proving I did my job than actually doing it. Every patient encounter generates an average of 47 data points that must be entered, coded, and transmitted to entities that have no role in that patient's care.
Regulations don't heal patients. They don't reduce blood pressure or set broken bones or calm a frightened child. They generate data for people who have never met the patient the data describes.
Why I Keep the Doors Open
I keep the clinic open because if I don't, the nearest alternative is 90 miles away. My patients — ranchers, teachers, retirees, kids — would have to drive two hours each way for a strep test.
I see this every day in my clinic. The gap between what Washington thinks healthcare looks like and what it actually looks like is the width of the country. And it's getting wider.
The fix isn't more regulation. It's less. Let me practice medicine. Let my patients access care. Get the Federal Register out of the exam room.
