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Administrative Duties and Physician Stress

Evan Winter

In the technological age, nearly every business entity implements some form of electronic record-keeping. Complex, data-driven systems allow for quick information sharing between employees, departments, or entire companies. Reduced physical storage space and greater protection of information lower overhead costs and provide piece-of-mind. Ease of data entry directly into record systems saves the time and energy of employees . . . Or does it? 

The trouble with tech

Even with access to such amazing technology and increased communication channels, there are a multitude of consequential struggles for those in healthcare, specifically physicians. Administrative duties such as completing electronic health records (EHR), gaining prior authorizations, and reporting performance measures have begun consuming doctors’ busy schedules over the past few decades. Many argue that these tasks are more time-intensive than they should be, and often require physicians to painstakingly justify their professional medical decisions to untrained parties, mainly insurance providers. All the time and energy doctors spend on administrative tasks not only take effort away from direct patient care, but also contribute significantly to physician burnout. 

How we got here

It took some time for these administrative duties to start causing physicians so much trouble. The inklings of what would become electronic health records (EHR) began to appear in the 1960s but did not fully come to fruition until the federal government, specifically the Department of Veteran Affairs and the Department of Defense, began using EHRs in the 1970s. Even with strong pushes by some medical organizations to embrace EHRs, by 2001, only 18% of physicians were using such systems. This began to change after the Bush administration significantly increased funding for healthcare IT projects and called for nationwide implementation of EHRs by the year 2014, contributing to EHR use growing from nearly 35% to more than 71% between the years of 2007 and 2012. With such rapid growth in technology implementation, federal officials, insurance providers, and other organizations began to expect greater documentation and collect more performance-related metrics, especially for primary care providers. In 2016, a study found that primary care physicians were spending around 49% of their workdays on administrative tasks and only 27% on clinical activities like seeing patients directly. 

Primary stressors 

Although hit the hardest, primary care physicians are not the only ones being weighed down by non-clinical duties. In a 2020 Medscape report, 55% percent of all physicians surveyed cited “too many bureaucratic tasks” as the chief contributor to their burnout symptoms. Many of these undesirable tasks are made more stressful by long lapses in time between communication points and technical issues with EHR systems. The communication required for prior authorizations is perhaps the largest pain point since it can tie up physicians with completing lengthy assessments, impede timely patient care, and undermine a physician’s medical authority. A 2017 American Medical Association (AMA) survey revealed that over 60% of physicians had to wait at least one business day to complete authorizations, and 30% had to wait at least three days. In that same survey, 86% of physicians reported time spent on prior authorizations increasing over the previous five years. EHRs, while in some ways helpful for sharing and storing large amounts of information, offer additional levels of stress for doctors. The systems are not one-size-fits-all, despite being treated as such, and lengthy entry requirements have physicians running out of time to complete records at the office. Multiple studies report physicians spending nearly twice the amount of time on EHRs as they do seeing patients, and around half of doctors say they must complete EHRs from home. 

The outlook

All the combined administrative issues are pushing a greater amount of physicians toward burnout at a faster rate than ever before. They are unable to see patients as often, which is what they trained for in the first place, and taking work home at the end of the day detracts from time spent with families and much needed sleep. In 2018, a study published in the Journal of the American Medical Informatics Association surveyed around 1,800 physicians and found that of the 91% who used EHRs, nearly 70% reported IT-related stress. Lack of support from administrators, little help in the way of medical assistants, and slow improvement of EHRs all exacerbate the existing problems, which are leading physicians away from patient care. With an ever-growing physician shortage, not only are our doctors in danger, but public health is suffering at large.