Exhausted and buried alive in an administrative avalanche?

Being a doctor is hard enough. But it’s what we signed up for and what we love to do. It’s the other stuff that sucks our time, sucks our energy and, well, just plain sucks. You know what I’m talking about: nonclinical demands, insurance forms, pharmacy refill faxes, fee-for-service billing and reviews, accounting, taxes, and all those human resource tasks involved in running a small business. The effects of these administrative burdens are real and serious. Studies estimate we spend about half of our time with patients—and a third with our EMR. It impacts quality of life, as only about 70% of Canadian doctors are satisfied. (Schaudenfraude alert: it’s only 50% in the United States.) Half of doctors report burnout and “bureaucracy” is the most common cause. Not coincidentally, half of Canadian doctors report poor work-life balance and 36% of doctors would not choose medicine again. So short of ignoring the growing stack of papers and digital rubbish—and please do not tell the College that it was my idea—what can be done? Firstly, value your expertise. We are skilled professionals and our time is valuable. There are guides to uninsured services, for example, but feel free to bill what you are worth. Unlike usual public payment systems where there are no modifiers for experience and few for advanced skills, this is where you get to set your value. Read: Don't get them started: Canada's worst forms Bill your work based on the skill required, the risk (such as with medicolegal opinions), the time needed, and the payer’s ability to pay. (For every camp form that I comp a sole parent who wants to give their kids a fun summer, there are plenty of travel insurance forms for people who are already painlessly paying thousands of dollars for a pleasure trip.) And be sure to add a valence multiplier: this work means time away from your own family and friends and leisure, so if you find the form particularly onerous then feel free to bill more. And if you feel guilty, just consider what a lawyer with your training and experience (or less) charges per 6 minutes. Try not to “multi”task. Our brains can’t do it, and, even if they could, Facebook and Twitter have already hacked into us with their algorithms. Social media makes money stealing our time, so silence those apps or turn off the phone entirely. Delegate “lesser” tasks. Training a staff person who to find and copy information is a worthy investment, especially when it comes to billing and forms. It’s usually easier to write “see attached” and have staff copy a patient’s chart onto a USB than it is to review and hand copy a patient’s history. Stay Zen and keep perspective: documentation and silos are embedded into modern North American patient care and will be until we have a better system that recognizes that timely, accessible information is necessary for quality care. Read: The pain of paperwork comes in many forms Set your refill boundaries. How do you want to deal with pharmacies? Do you want to fax, eFax, or verbally communicate with pharmacies? Let them know your preference and if they don’t respect it tell them that you’ll recommend their customers go elsewhere. If you are in a province where refills are an insured service, then bill for it. If not, consider billing the patient for the time and travel that you have saved them. Set your email and text boundaries. I have set up “dummy” email and texting accounts that patients can use; I let them know what these are for—short, quick, non-urgent questions and triaging—and the consequences for inappropriate use (that is, they will be blocked and have to book to see me.) Be careful with meetings: they can creep and fester, stealing time and your soul. Before accepting an invitation, ask: What is the outcome? How much time do we need? Can this be done by text/email? Conversely, there is some value to meeting the right people in person: the ubiquity of Zoom due to pandemic distancing has meant less time traveling to meetings, but also takes away relationship-building that is so important in these polarized times. While EMRs have not lead to the envisioned paperless office (it’s actually worsened it), there are ways to make them less evil. Typing templates for common histories, examinations, care plans, and letters can save time. Common forms can be enriched and brought into EMRs. Others, such as the infamous Disability Tax Credit are now fillable online (https://apps.cra-arc.gc.ca/ebci/uisp/dtc/ng/practitioner.) EFaxing can save time and trees. Online booking systems are common, either as native to EMRs, or as APIs. Dictate when you can, but proof-read after so you don’t report on a “bologna amputation.” Patient portals and pre-visit questionnaires collect patient information and occupy patients while they wait for their appointments. Those are a few of my ideas; feel free to contribute yours. (And, of course, read John Crosby’s free e- and audiobooks.) Thank you for taking some of your precious time to read this. Eric Cadesky is a Family Physician in Vancouver, BC Read: Who will save primary care?

Exhausted and buried alive in an administrative avalanche?

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