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Study: Paperwork Consumes One-Sixth of U.S. Physicians’ Time, Erodes Morale

Electronic health records increase docs’ bureaucratic burden, authors say

The average U.S. physician spends 16.6% of his or her working hours on non–patient-related paperwork, time that might otherwise be spent caring for patients. And the more time doctors spend on such bureaucratic tasks, the unhappier they are about having chosen medicine as a career.

These are some of the findings of a nationwide study published in the International Journal of Health Services.

Drs. Steffie Woolhandler and David Himmelstein, professors of public health at the City University of New York, analyzed data from the 2008 Health Tracking Physician Survey (the most recent data available), which collected information from a nationally representative sample of 4,720 physicians who practiced at least 20 hours per week.

They found that, on average, doctors spent 8.7 hours per week, or 16.6% of their working time, on administration. This included tasks such as billing, obtaining insurance approvals, financial and personnel management, and negotiating contracts. It excluded patient-related tasks, such as writing chart notes, communicating with other doctors, and ordering lab tests.

In total, patient-care physicians spent 168.4 million hours on administrative chores in 2008. The authors estimate that the total cost of physician time spent on administration in 2014 will amount to $102 billion.

Career satisfaction was lower for physicians who spent more time on administration. “Very satisfied” doctors spent, on average, 16.1% of their time on administration. “Very dissatisfied” doctors spent 20.6% of their time on such tasks.

Among various specialties, psychiatrists spent the most time on administration (20.3%), followed by internists (17.3%) and family/general practitioners (17.3%). Pediatricians spent the least amount of time (14.1%) on non–patient-related administrative tasks and also were the most satisfied group of doctors.

While solo practice was associated with more administrative work, small group practice was not. Doctors practicing in groups of 100 or more actually spent more time (19.7%) on administrative tasks than did those in small groups (16.3%).

Interestingly, the authors noted that physicians who used electronic health records spent more time (17.2% for those using entirely electronic records and 18.0% for those using a mix of paper and electronic) on administration than did those who used only paper records (15.5%).

“Although proponents of electronic medical records have long promised a reduction in doctors’ paperwork,” the authors said, “we found the reverse is true.”

The investigators cite data showing that physicians in Canada spend far less time on administration than do U.S. doctors, and they attribute the difference to Canada’s single-payer system, which has greatly simplified billing and reduced bureaucracy.

The authors point out that the only other nationally representative survey of this kind was conducted in 1995. In that study, administration and insurance-related matters accounted for 13.5% of physicians’ total work time. Other, less-representative studies also suggested that the bureaucratic burden on physicians has grown over the past two decades, the authors noted.

“American doctors are drowning in paperwork,” Woolhandler concluded. “Our study almost certainly understates physicians’ current administrative burden. Since 2008, when the survey we analyzed was collected, tens of thousands of doctors have moved from small private practices with minimal bureaucracy into giant group practices where bureaucracy is rampant. And under the accountable care organizations favored by insurers, more doctors are facing HMO-type incentives to deny care to their patients, a move that our data show drives up administrative work.”

Source: EurekAlert; October 23, 2014.

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