Research: American doctors are ‘drowning in paperwork’
Monday, November 10, 2014
According to a new study, U.S. doctors spend nearly 17 percent of their working lives on nonpatient-related paperwork — time that might otherwise be spent caring for patients. The findings also suggest that the more time doctors spend on such tasks, the unhappier they are about having chosen medicine as a career.
This data comes from new research conducted by Drs. Steffie Woolhandler and David Himmelstein, internists in the South Bronx who serve as professors of public health at the City University of New York and are lecturers in medicine at the Harvard Medical School. The results of the study were published in October by the International Journal of Health Services.
The authors of the study analyzed data from the 2008 Health Tracking Physician Survey (the most recent data available) that collected information from a national sample of 4,720 physicians practicing at least 20 hours per week. The researchers determined that an average doctor spends more than eight hours per week performing administration functions.
However, of note is the fact that this does not include time spent performing patient-related tasks like writing chart notes, communicating with other doctors and ordering labs. Specifically, administrative tasks are defined as "billing, obtaining insurance approvals, financial and personnel management and negotiating contracts."
Of the population surveyed, the doctors spent 168.4 million hours on these tasks in 2008. The authors estimate that the total cost of physician time spent on administration in 2014 will amount to $102 billion, and they pointed out that physicians who used electronic health records actually spent more time (17.2 percent for those using entirely electronic records, 18 percent for those using a mix of paper and electronic) on administration than those who used only paper records (15.5 percent).
"Although proponents of electronic medical records have long promised a reduction in doctors' paperwork, we found the reverse is true," the authors wrote.
The more time spent on these tasks meant physicians were less happy with their work than those who did less of this work. Psychiatrists spent the most time on administration (20.3 percent), followed by internists (17.3 percent) and family/general practitioners (17.3 percent). Pediatricians spent the least amount of time (14.1 percent) on nonpatient-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," Woolhandler and Himmelstein concluded. "Doctors practicing in groups of 100 or more actually spent more time (19.7 percent) on such tasks than those in small groups (16.3 percent)."
They point out that the only previous nationally representative survey of this kind was carried out in 1995, and that study showed that administration and insurance-related matters accounted for 13.5 percent of physicians' total work time. Other, less representative studies, also suggest the bureaucratic burden on physicians has grown over the past two decades.
"American doctors are drowning in paperwork," said lead author Dr. Woolhandler. "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 shows drives up administrative work. Administrative work consumes one-sixth of U.S. physicians' working hours and lowers their career satisfaction."
This study and its findings parallel that of another recent study in September that was conducted by The Physicians Foundation related to physician satisfaction with their careers. That study suggests that U.S. patients may face growing challenges accessing care if shifting patterns in medical practice configurations and physician workforce trends continue.
According to the study, titled "2014 Survey of America's Physicians: Practice Patterns and Perspectives," 81 percent of physicians describe themselves as either overextended or at full capacity, while only 19 percent indicate they have time to see more patients.
Of those physicians surveyed, 44 percent plan to take steps that would reduce patient access to their services, including cutting back on patients seen, retiring, working part-time, closing their practice to new patients or seeking nonclinical jobs, leading to the potential loss of tens of thousands of full-time-equivalents.
"America's physician workforce is undergoing significant changes," said Walker Ray, M.D., vice president of The Physicians Foundation and chair of its Research Committee. "Physicians are younger, more are working in employed practice settings and more are leaving private practice. This new guard of physicians report having less capacity to take on additional patients.
"These trends carry significant implications for patient access to care. With more physicians retiring and an increasing number of doctors, particularly younger physicians, planning to switch in whole or in part to concierge medicine, we could see a limiting effect on physician supply and, ultimately, on the ability of the U.S. healthcare system to properly care for millions of new patients."
The survey is based on responses from 20,088 physicians across the U.S.
"The state of the physician workforce, and medicine in general, is experiencing a period of massive transition," said Lou Goodman, Ph.D., president of The Physicians Foundation and CEO of the Texas Medical Association. "As such, the growing diversity of the physician workforce will reflect different perspectives and sentiments surrounding the state of medicine.
"While I am troubled that a majority of physicians are pessimistic about the state of medicine, I am heartened by the fact that 71 percent of physicians would still choose to be a physician if they had to do it over, while nearly 80 percent describe patient relationships as the most satisfying factor about practicing medicine."
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