December 17, 2016

How Much Paperwork for a Doctor and Other Professions?

Image courtesy of Gualberto107
The Annals of Internal Medicine recently published a paper which investigated how much time a doctor spends on paperwork after following 57 U.S. physicians in family medicine, internal medicine, cardiology, and orthopedics who were observed for 430 hours, 21 of whom also completed after-hours diaries.

The conclusion was during a typical day, 27.0% of their total time was on direct clinical face time with patients and 49.2% on "paperwork." The missing percentages were spent on other activities.

The explosion in paperwork probably occurred around the time when the government implemented electronic health records incentives and certification requirements known as "Meaningful Use." These rules came into existence when the American Recovery and Reinvestment Act of 2009 (Recovery Act) was passed into law.

If physicians successfully implement "Meaningful Use" requirements, bonus payments will be paid out that can be in the tens of thousands of dollars. About $63,750 per year if all steps followed.

If physicians do NOT implement "Meaningful Use" requirements, not only would these bonus payments not be given, but base pay would also be cut 1-3% on a graduated scale over time.

What exactly is "Meaningful Use?" It's basically paperwork. Lots of it. It's why a typical doctor's note  documenting a 5 min office visit may be 5+ pages long full of useless information.

So much of the paperwork being generated is actually self-inflicted in order to get a bonus pay AND avoid a base pay cut. These requirements apply to both hospitals as well as offices.

However, physicians do NOT have to comply with meaningful use, and a minority do not in order to avoid the unnecessary paperwork (like our practice).  Of course, elements of Meaningful Use that make sense ARE incorporated into practice, but everything else that do not are deliberately ignored. Of course, that means that such practices do not get bonus pay AND get a baseline pay cut.

But, that's OK... because it is not just about the paperwork... It's also a financial and patient care decision. The amount of time saved avoiding paperwork can be used to spend more time with patients as well as see more patients. So, even without the bonus pay on top of a baseline pay cut, the financial end result may come out almost the same, especially if taking into consideration the cost savings in avoiding expensive computer software updates to keep up with meaningful use requirements. I'm sure someone somewhere must have done a study on this trade-off.

Of course, there are paperwork that we have no control over related to insurance... authorizations for medications/tests/surgeries, disability paperwork for patients, etc.

Regardless, physicians do seem to cry a lot about how much paperwork we have to do... But honestly,  it's something that many professions have to deal with. It's definitely not unique to just medicine.

Lawyers seem to swim in paperwork... Piles and piles of it.

Police officers are estimated to spend about 80%+ of their time on paperwork.

Nurses spend about 80% of their time on paperwork.

Scientists spend a not insignificant amount of time on paperwork related to getting money to fund their research.

Teachers also spend an inordinate amount of time (~40%) on paperwork (grading homework and giving out grades).

Just personal observation through buying a home with a mortgage, I suspect the financial sector has quite a bit of paperwork as well.

Allocation of Physician Time in Ambulatory Practice: A Time and Motion Study in 4 Specialties. Ann Intern Med. 2016;165(11):753-760.
Fauquier blog
Fauquier ENT

Dr. Christopher Chang is a private practice otolaryngology, head & neck surgeon specializing in the treatment of problems related to the ear, nose, and throat. Located in Warrenton, VA about 45 minutes west of Washington DC, he also provides inhalant allergy testing/treatment, hearing tests, and dispenses hearing aids.

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