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Study: Administrative Burden Greater for Physicians Who Use EHRs

The average US doctor 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 by Steffie Woolhandler, MD, MPH, and David Himmelstein, MD, internists in the South Bronx who serve as professors of public health at the City University of New York and lecturers in medicine at Harvard Medical School. The study was published recently in the peer-reviewed International Journal of Health Services.

Woolhandler and Himmelstein analyzed confidential 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 the average doctor spent 8.7 hours per week, or 16.6% of their working time, on administration. This excludes patient-related tasks such as writing chart notes, communicating with other doctors, and ordering lab tests. It includes tasks such as billing, obtaining insurance approvals, financial and personnel management, and negotiating contracts.

In total, patient-care physicians spent 168.4 million hours on such administrative tasks 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 such tasks than those in small groups (16.3%).

Interestingly, the authors noted that physicians who used EHRs spent more time (17.2% for those using entirely electronic records, 18% for those using a mix of paper and electronic) on administration than those who used only paper records (15.5 %).

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

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

They pointed 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% 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,” says lead author 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.”

Himmelstein comments: “Our crazy health financing system is demoralizing doctors and wasting vast resources. Turning health care into a business means we spend more and more time on billing, insurance paperwork, and the bottom line. We need to move to a simple, nonprofit national health insurance system that lets doctors and hospitals focus on patients, not finances.”

Source: Physicians for a National Health Program