As I’ve talked to people at various conferences and throughout the state, physician burnout is a common, and impassioned, discussion topic. An interesting perspective on this problem was penned by a blogger on a recent AAFP article where he typed “it is ridiculous to offer seminars and instruction to physicians about burnout. The problem is not with hard-working doctors, but with the system. It does not take a genius to realize this. These seminars should be offered to administrators, "health care experts", CEOs, and government officials”.
But, what’s the major driver of the burnout problem? As described by the blogger above I hear the frequent refrain of “don’t fix me, fix the system”. The major contributor seems to be encompassed under administrative burden. From EMR searching and charting, to paperwork demands and requirements for referrals to specialists/tests/procedures, all add up to a time black hole (I am a geriatrician so even more acutely aware of the paperwork hassles). This is on top of the usual administrative functions which we would all expect for a typical doctor’s office like Rx refills and medical questions which come in from patients.
A 2016 article published in the Annals of Internal Medicine reported that during a typical day, primary care physicians spend 27 percent of their time on direct patient care but a jaw-dropping 49 percent on administrative activities. Does anyone think this problem has gone down since publication? This is an absolutely stunning breakdown of our time demands when everyone, everywhere would agree that we obviously should be spending the (large) majority of our time on direct clinical activities. These requirements are particularly taxing on independent practices who have fewer resources to accommodate the extra workload than large health systems.
Administrative burden doesn’t benefit patients or enhance our ability to care for them. It does serve to frustrate and anger us. We don’t have control over how much flow of administrative nonsense hits our doorstep. It wastes time which could be spent doing more productive endeavors. It does not enhance patient care. It does delay patient care. The best we can do is pass it on to staff who experience the same feelings we do. I actually lost my last Medical Assistant to this very problem. She was fed up with filling out forms instead of doing more productive direct patient assistance. She went to an OB group mainly because she tired of these demands, not for the higher salary they were able to pay her (so she said). She had the perspective of having worked in several different clinical specialties and said that primary care, “by far”, was the worst for paperwork frustrations.
Administrative burden has certainly been increasing as none of these examples would have been relevant 5-10 years ago:
In the AAFP’s most recent member survey, administrative burden was the No. 1 item that members asked the Academy to help them with. On the AAFP article webpages, there are frequently comments stating the AAFP isn’t doing enough or doesn’t “get it”. On this specific issue, I know that they indeed “get it” in spades. AAFP has made this a top priority in their legislative agenda. Academy leaders and lobbyists regularly visit Capitol Hill to push for changes. CMS specifically has been targeted by the AAFP. During a recent national conference, Administrator Verma scrapped a pre-planned PowerPoint lecture in lieu of an impromptu town hall to hear comments from members. CMS has launched an initiative called Patients over Paperwork. Change is slow with many parties including EMR companies, insurance companies, big PHARMA, governmental agencies, as well as Congress needing to be influenced. If our national academy isn’t fighting for us against these large bureaucracies, no one will.
Oorrrr we can start doing more Direct Primary Care! That would get rid of most, or pretty much all, the hassles. But that’s a topic for another day.
Work for change doesn’t happen in isolation. It will only happen if you support the AAFP with your dues and PAC contributions. There are some things that WAFP can do in the state. An example would be legislatively requiring that insurance companies use a standardized PA form. What do you think? I’d like to hear from you at president@WAFP.com.
Thank you for being a member of OUR academies! Please consider donating to our PACS to fight for administrative and legislative change.