A Medical Degree in Paperwork

A recent study in Annals of Internal Medicine found that physicians in four office-based specialties spent the majority of their time on documentation and paperwork:

• Overall, physicians spent 27.0% of their total time on direct clinical face time with patients and 49.2% of their time on documentation (paper and electronic).
• While in the examination room with patients, physicians spent 52.9% of the time on direct clinical face time and 37.0% on documentation.
• Physicians reported 1 to 2 hours of after-hours work each night, devoted mostly to electronic health record tasks.

A Forbes commentary noted there was a steady increase in the proportion of physician time taken up by paperwork. Reasons for this trend include

• The multitude of diverse stakeholders requiring increasing amounts of documentation in the paperwork, including administration, lawyers and insurance companies. For example, for a patient with a broken arm, insurance companies require that we ask about at least ten organ systems (a “review of systems“) and document our findings completely. So at least part of that clinical face time is spent asking the patient with the broken arm about things like pain with urination and visual change.
• The stakeholders, and not the physicians, design the forms, and so they are not designed in a way that fits a medical way of thinking about a patient encounter and are often redundant. For example, when I transfer a patient from one hospital to another, I fill out a form for the lawyers (the EMTALA form, explaining the medical necessity of the transfer) and a form for the insurers explaining the medical necessity of the transfer. These contain a lot of the same information.
• Hospitals and clinics do not seem to be investing in clerical and administrative support for doctors, sometimes because of regulations requiring a physician complete the forms. For example, 90% of the information on the two transfer rationale forms I mentioned above both could be completed by clerical personnel, or could be copied by a non-MD from one form onto the other.

The Forbes piece notes that the trend pushing ever increasing paperwork burdens onto physicians is a recipe for low career satisfaction and burnout.