The administrative burden on physicians has been growing for years. But in the context of an ongoing health care crisis, it’s taking a new toll on doctors and the health system. The CMA spoke with 2023-2024 president Dr. Kathleen Ross, a family doctor in BC, about why paperwork keeps piling up and what fixing it could mean for the profession.
Why is the CMA calling for a national effort to reduce the administrative burden in medicine?
In a CMA survey of thousands of physicians, 60% said administrative burden is a direct contributor to burnout, worsening mental health and all the things that go along with that — including reducing hours or, in some cases, stepping away from the profession or retiring early.
I can tell you from personal experience that the administrative burden isn't just one thing. It’s a whole bunch of small tasks that chip away at our time with patients, that human-to-human connection that we want to engage in as care providers. It saps our energy and takes some of the joy out of practicing medicine.
When we talk about the admin burden, is it different than the paperwork in other professions?
Like any profession, there’s essential paperwork in medicine. You need to write down what you did, you need to be able to collect information on tests that you ordered or processes that are underway, and you need to be able to integrate the results into a patient’s chart and care plan. But, on average, physicians spend more than 10 hours a week on administrative tasks, often working after hours. Too much of that is either inefficient, duplicative, or could be eliminated entirely.
Insurance forms related to rehabilitation are one example. Physicians are often asked: How far can your patient carry such-and-such? How many stairs can they climb? How many times can they bend from their waist to the floor? Should we be filling out those forms? I think many of us would argue no.
We need to be very cautious, though, as we're addressing the administrative burden on physicians, that we're not just downloading the work onto someone else. We need to have a hard look at what's being asked for in the way of insurance forms, disability applications, medical notes, etc., to decide whether this work is actually necessary in the first place.
How important is it for an employer or an insurance agent to understand how far I can carry five kilograms, if I think I can be back at my desk job? What are the things that we're doing outside of our routine office hours that are not serving patient needs?
Have Electronic Medical Records (EMRs) cut down on the administrative load at all?
I was an early adopter of EMRs. I'm quoted as saying they’d substantially decrease our workload. Instead, I think we’ve had a substantial increase because information is not condensed or coalesced appropriately.
It would have been too expensive to mail partial lab results, for example; instead, we would get a stack of complete results once daily and look at them once daily. Now, I see five or six copies of the same results daily electronically, and each result shows up as a new or unreviewed document. For each one I have to open a patient’s chart to see whether a colleague has addressed the information. Going digital has really added to the noise.
At the same time, there’s a lack of interoperability between digital systems so physicians may not have access to important information outside their own practice or health authority.
What’s the biggest obstacle to change?
I'll quote The Lord of the Rings: It’s the job that's never started that takes the longest to finish. The administrative burden in medicine has been building and building, but there’s a lack of awareness of this as a shared problem, of the impact on providers and patients. This issue needs to be at the forefront of a national discussion if we’re going to move the needle.
The consequence of not moving forward is that physicians continue to burn out, particularly primary care providers, who face the biggest administrative burden, and people will continue to step away from medicine.
How is the CMA approaching this problem?
Provincial and territorial medical associations have been driving significant reforms to address administrative burden. We’re working with them, and with other partners across the country, to understand shared pain points, root causes and, critically, to scale solutions. We’ll also be advocating for streamlined national forms, and for Ottawa to mandate the interoperability of health data. We can have a more efficient health system and give physicians back the time to focus on care — not busy work.
This interview has been edited and condensed.