23 Oct Physicians Frustrated By Administrative Burdens of Medical Practice
MedicalResearch.com Interview with:
Dr. Steffie Woolhandler MD MPH
Professor of Public Health and City University of
New York, Lecturer (formerly Professor of
Medicine) at Harvard Medical School
Primary Care Physician Practicing in the South Bronx
Medical Research: What is the background for this study?
Dr. Woolhandler: Physicians like myself are extremely frustrated
by the administrative burdens of medical
practice. Many hours of physicians’ time each
week go to administrative work completely
unrelated to good patient care, but mandated by
private insurers and other payers. Colleagues
often tell me that they love seeing patients but
are getting burned out by the paperwork.
Medical Research: What are the main findings?
Dr. Woolhandler: We found that the average practicing U.S.
physician spends 8.7 hours per week, 16.6% of his
or her working hours, on non-patient related
paperwork. (This figure excludes time spent
writing progress notes, communicating with other
doctors, or ordering tests, which we considered
patient-related work. However, it includes
billing, obtaining insurance referrals, financial
and personnel management, and contract
negotiations). Pediatricians spent the least
time of any specialty on paperwork (14.1% of
their work week) and psychiatrist the most
(20.3%). Spending more time on paperwork
significantly reduced physicians’ career
satisfaction. Overall, U.S. physicians spent
168.4 million hours on paperwork in 2008, at an
opportunity cost of $102 billion in lost patient-care time.
Unfortunately, many ongoing changes in medical
practice are likely to increase, rather than
decrease doctors’ administrative burden. For
instance, physicians are moving into large group
practices, but physicians in such practices
actually face more paperwork than those in small
groups. Similarly, electronic medical records
are associated with a higher share of physicians’
working hours being devoted to administration.
Medical Research: What should clinicians and patients take away from your report?
Dr. Woolhandler: Physicians, patients and policymakers need to be
advocating for a payment system that lets doctors
spend their time on patients, not
administration. This means switching to a
simple, single payer system, that is, non-profit,
tax-funded national health insurance. Private
health insurance firms not only generate their
own byzantine and expensive bureaucracies, but
impose huge bureaucratic burdens on patients and physicians.
Medical Research: What recommendations do you have for future
research as a result of this study?
Dr. Woolhandler: Patients and families also face a huge bureaucratic burden
dealing with insurance enrollment, copayments,
deductibles, referrals and finding doctors in
the “narrow networks” that private insurers
increasingly impose. Virtually no research has
assessed the time spent by patients on such
tasks. In addition, there has been no recent
research on the amount of time spent by doctors
in single payer systems such as Canada’s on
paperwork, although anecdotally, physicians there
report very little administrative work and
relatively high career satisfaction.
Citation:
Administrative work consumes one-sixth of U.S. physicians’ working hours and lowers their career satisfaction,” Steffie Woolhandler, M.D., M.P.H., and David U. Himmelstein, M.D.
International Journal of Health Services, Vol. 44, No. 4.
Last Updated on October 24, 2014 by Marie Benz MD FAAD