The paperwork burden weighing on Canadian physicians

Every day, a familiar scene plays out across clinics: family physicians in Ontario wrapping up a long day of back-to-back consults with patients. After spending time with patients, they’ve completed patient charting and coordinated specialist referrals – and yet an additional checklist looms: the work invisible to patients that is essential to keeping the practices running.

These are non-clinical, administrative tasks such as general office management, billing and managing staff. Time-strapped family physicians are forced to vacillate between the clinical and non-clinical aspects of their work while maintaining a high degree of quality patient care.

This juggling act is taking a serious toll at the individual practitioner level and across the health system. A recent survey of 500 physicians across Ontario, Alberta and British Columbia reveals the extent of this burgeoning health workforce crisis – and the grave repercussions of unchecked administrative work.

Physicians across various care settings, such as community and academic hospitals, multidisciplinary, academic and solo clinics, talk about the true cost of the unspoken aspects of running a practice. Prevalent issues include the unpaid hours devoted to tackling administrative activities, navigating a labyrinth of compliance requirements and dealing with billing complexity. Ultimately, these tasks are fueling burnout in the profession and creating inefficiencies the system and patients cannot afford.

One-third of survey respondents reported spending more than 10 hours per week on non-clinical tasks, while more than 60 per cent spend more than five hours per week on them. An average of 7.5 hours – the equivalent of one working day – are devoted to non-clinical tasks. Eight-five per cent tackled non-clinical administrative work outside of their normal working hours, further exacerbating burnout and strain.

More than 75 per cent of physicians report that non-clinical administrative burden is reducing the time they can spend with their patients. This alarming trend is corroborated by data that shows physicians are now seeing fewer patients on average than in the past. Physicians cited in the report say the pressure of balancing competing priorities creates real challenges to providing care.

In Ontario, family physicians are so overwhelmed that they are considering leaving their practices, citing “system-wide issues including overwhelming administrative burden”.

This unsettling statement confirms the sentiment in the recent white paper: More than 70 per cent of physicians say that the non-clinical administrative aspect of their work is significantly contributing to their individual burnout and workplace exhaustion. The administrative burden associated with running a practice is fueling dissatisfaction among 78 per cent of respondents, an equally alarming statistic.

Running a clinic is a bit like being an entrepreneur with the physician playing both roles as care provider and small business owner. Management essentials, like billing, are shouldered by doctors, every day. Despite being funded, complex medical care and out-of-date billing models create common instances when doctors pay out of pocket to effectively run their clinic.

The survey also reveals that tasks related to billing were ranked as the most time-consuming, both overall and in terms of extra time spent outside of working. What’s more, billing tasks also emerged as the most complex for physicians to complete. Almost 70 per cent of respondents identified challenges with both unclear billing rejections/refusals, and the paperwork for non-provincial insured services already provided. As a result, physicians are required to closely monitor insured service submissions and then potentially spend more time fixing rejected ones to ensure they are appropriately compensated.

Between navigating the complexity of insurance forms for services not covered by provinces and outdated billing models, physicians are left to manage accounting intricacies with little to no guidance.

Altogether, multiple pressures physicians bear beyond patient care delivery contribute to professional burnout and puts retention and recruitment at risk. This poses a serious problem, further threatening patient access during a particularly precarious time when an estimated 6.5 million Canadians are already without a family physician. With 22 per cent of survey respondents saying they’re finding the administrative aspects “much harder now than it used to be,” it’s critical  to address this worsening issue.

What’s the prescription for physician burnout? Intervention is required to simplify non-clinical workflows and alleviate the administrative burden on physicians. Opportunities include working toward:

• Reducing barriers to responsibly leveraging emerging technologies, such as artificial intelligence that can automate and augment activities such as administrative notes, suggest billing codes and seamlessly integrate billing software with clinical software;
• Improving data standards and sharing across health systems to strengthen data integration and interoperability;
• Modernizing provincial billing systems to be more user-friendly and responsive to the needs of clinicians, such as revising current descriptions and criteria to reduce rejections;
• Enhancing the tools and supports that will enable physicians to bill with more accuracy and confidence, such as dedicated concierge services;
• Expanding education for physicians in operational and non-clinical practice management; and
• Supporting the creation of physician peer support groups for non-clinical administrative burden and practice management.

All solutions should support freeing up physicians for what they truly signed up for: delivering patient care in a timely, precise and meaningful way.