Juggling Paperwork With Patient Care – A Physician’s Administrative Burden
Many doctors believe that the amount of administrative work that is currently required to admit, treat and release each patient is an overwhelming burden and takes away from valuable face-to-face time. What’s more, there is a disconnect between what medical students are being exposed to and the actual day to day tedious tasks demanded of doctors once they are in the field. In a study of 6,000 doctors, more than half responded that they were required to do way too much administratively. While regulators may have good intentions when instituting these additional duties, such as quality improvement, fraud prevention or patient access to charting, not having enough face-to-face time between the patient and physician takes away from the very premise of medical care. A disconnect exists between the patient and his or her doctor as they interact less and the patient begins to feel more like a number than a human being.
Studies have shown that internal medicine interns spend a whopping 40 percent of their time on computers, while residents on average spent more than four hour per day on documentation and charting. Researchers also found that doctors in clinics spent approximately two hours at their desks per every one hour of patient face-to-face interaction. A nationwide study found that more than 90 percent of residents thought the required documentation was too much, and medical journals have contended that the administrative work required of doctors is a top reason for burnout in the field.
Add the Internet to the hard-copy load and we have a whole new level of complexity in data entry slowing down the physician’s routine and creating long, strenuous hours each day. Many doctors are given computer credentials and a login for electronic medical charting, pagers, and access codes to certain sections of the building, and if any of these electronics malfunction, a day is wasted on the phone with the IT department trying to eradicate the issue. Work piles up, vital questions from staff go unanswered and patients are left waiting. The doctor’s daily check off list doubles. This burden, therefore, increases operating costs, rather than decreasing the bottom line, and subsequently increases physician turnover.
The American Academy of Family Physicians (AAFP) is actively working on reducing the administrative burden put on physicians on a daily basis, but efforts have been slow to gain traction and those in the field are still working with high expectations and low financial margins. On April 26th, the AAFP wrote the Centers for Medicare and Medicaid Services (CMS) Administrator Seema Verma about its top priority to make changes to the administrative burden. The AAPF and CMS meet on both in April and in May to review recommendations for how the Quality Payment Program (QPP) could be simplified in order to decrease the need for administrative work. The proposal included what the AAFP has referred to as “common sense approaches that would reduce the quality reporting requirements, decrease the prescriptive nature of the Advancing Care Information requirements, and allow for a greater number of family physicians to participate in primary care alternative payment models”. The organization has reported that both meetings went well and the CMS is reviewing proposed regulatory modifications. In the meantime, doctors will have to maintain their strenuous routines, continuing to juggle paperwork with patient care.