“I am absolutely drowning”
Canadian MDs spend 18.5 million hours each year on unnecessary administrative work, but provinces appear motivated to make change
Administrative burden is eating away at the time physicians want to spend with patients. In three articles, we address the efforts being made to put patients before paperwork, clarify the obligation of specialists and family physicians, and answer some FAQs about medical documentation.
Dr. Nicolette Fellegi knows that charting is part of medical practice. But she has reached her breaking point. “I am absolutely drowning,” says the Ottawa family physician.
Dr. Fellegi, who has been in practice for more than 30 years and has an older patient population, says she can spend as much as 25 hours a week charting, filling out third-party forms and sick notes, managing an office, tracking down lab results, making referrals, and following up on patient appointments. She starts doing her paperwork before breakfast and finishes just before heading to bed.
The frustrations she is facing will likely compel Dr. Fellegi to retire shortly — seven years earlier than she planned. “I had expected to retire around the same time as my husband [Dr. Tom Kovesi, a pediatric respirologist], but I doubt I can hang on. This is not how I want to practise or how I want to live.”
Dr. Fellegi is far from alone in her desperation. Earlier this year, the Canadian Federation of Independent Business (CFIB) released a report, “Patients before Paperwork,” which found Canadian physicians are spending 18.5 million hours each year on unnecessary administrative work — the equivalent of 55.6 million patient visits.
Based on a study of Nova Scotia doctors, 62 percent of administrative tasks were necessary, meaning 38 percent are unnecessary. The unnecessary administrative work included tasks that could be completed by someone other than a physician, such as an administrative assistant (24 percent), and tasks that could likely be eliminated (14 percent).
While most physicians say administrative burden is too high, family physicians appear to bear the brunt of the work. And while family medicine has been the quarterback for all care in the system, it’s been undervalued, with innovations rarely, if ever, focused on family medicine workflow, says Dr. Kathleen Ross, the new Canadian Medical Association President and a British Columbia family physician.
The administrative burden faced by family physicians was the topic at a panel discussion of the CMA Health Summit in mid-August. Panellists spoke of both the magnitude of the problem and reasons for optimism.
Dr. Chandi Chandrasena, the chief medical officer at Ontario MD, which supports physician adoption and use of EMRs and other digital health tools, acknowledged technology is a “double-edged sword” in that it is both a solution and a generator of administrative burden.
Dr. Chandrasena, who practised as a family physician for 20 years, says charting has always been a part of being a doctor. What changed is the red tape on top of that: cumbersome referral processes, a plethora of forms from numerous sources — both federal and provincial — and significantly, a lack of EMR integration necessitating access to multiple online portals for patient information.
As an example of burden, she raised the issue of the Health Report Manager (HRM), the technology that allows a hospitalist to seamlessly send their reports directly into physicians’ EMRs.
“So it bypasses your fax and your mail. Sounds great, does it not? Well, it’s an excellent technology in that it allows integration. But when it was started, we didn’t have any regulations or guidelines as to what you could actually send through it. And with no guidelines as to what can go through it, everything is going through it,” said Dr. Chandrasena.
But she said solutions are being created and to that end, a task force is in the process of releasing guidelines.
The Ontario Medical Association and the provincial government have also looked at forms — digital and paper — that could be streamlined, eliminated completely or filled out by someone other than a physician. The group has begun its work by making improvements to 12 OMA endorsed priority government forms.
“We’ve said ‘don’t create more burden for us and don’t offload work that doesn’t necessarily have to be done by a physician just because it’s easy to do with technology,’” said Dr. Chandrasena.
Ms. Corinne Pohlmann, Executive Vice-President, Advocacy, CFIB, points to the efforts being made in Nova Scotia, which has seen the provincial government collaborate with the medical association to estimate the administrative burden and its impact, identify key red tape irritants to resolve, and set measurable targets to reduce physician red tape. Even a small reduction could result in a significant number of additional patient visits. The Nova Scotia government has committed to reducing physician red tape by 10 percent — roughly 50,000 hours — by 2024.
Some other efforts include:
- The Ontario government wants to replace fax machines with digital communications for all Ontario clinicians within the next five years. In 2022, there were 152 million faxes across Ontario’s health care settings. By eliminating faxing in health care settings, the ministry says it will not only reduce the risk of delays in diagnosis and treatment while making it easier for health data to follow the patient wherever they access care, it will also reduce the administrative burden on health care providers.
- In British Columbia, patients, in many cases, can now continue seeing their consultant or specialist for an ongoing problem without having to go back to the referring doctor (usually their family doctor) every six months for a referral.
- Employers in Nova Scotia can no longer request a sick note unless the employee is absent for more than five working days or has already had two absences for illness within the previous 12 months.
If governments across Canada would follow Nova Scotia’s example and commit to reducing physician red tape by 10 percent, they could free up nearly 1.9 million hours of physician time — the equivalent of more than 5.5 million patient visits, says Ms. Pohlmann.
While it is unlikely all of the time saved would be converted directly into patient-care hours, she says, this moderate reduction in physician red tape would help reduce physician fatigue and burnout, potentially improving physician retention and the overall patient experience.
Using 2021 data from a survey of Nova Scotia doctors, the Canadian Federation of Independent Business (CFIB) extrapolated the results for Nova Scotia to all other provinces and territories to estimate the physician administrative burden across Canada.
Based on a study of Nova Scotia doctors, 38 percent of administrative tasks were unnecessary (red tape). Twenty-four percent of the unnecessary administrative work could be completed by someone else and 14 percent of tasks that could likely be eliminated.
If governments across Canada were to commit to reducing physician red tape by 10 percent, as Nova Scotia has done, they could free up nearly 1.9 million hours of physician time — the equivalent of more than 5.5 million patient visits.
It estimates physicians in Canada cumulatively spend 48.8 million hours per year on administrative tasks. Of this total, 30.3 million hours could be considered necessary, while 18.5 million hours are unnecessary. Using the Nova Scotia findings, CFIB estimates that of the time spent on unnecessary administrative tasks, 11.7 million hours of administrative work could be done by another professional, while 6.8 million hours could simply be eliminated.
Source: Canadian Federation of Independent Business estimates based on Nova Scotia findings