Paperwork, wait times plague physicians

Workload avalanche tops your list of practice complaints

"It seems like everything I do generates a note of some kind," says Dr Geoffrey M Holdway, a GP in a large group practice whose volume of paperwork sometimes seems insurmountable. "I'll spend a Sunday afternoon doing five hours of paperwork to clear my desk, and then when I come in on Monday I have another three hours' worth waiting for me."

Dr Irene D'Souza, a suburban Toronto-based GP specializing in occupational medicine, spends a good portion of each day methodically going through patients' medical histories, some of which amount to 6-inch stacks of paper. "It's my main beef," she says of her endless paperwork.

Dr Holdway and Dr D'Souza are not alone in their concern: paperwork topped NRM's 2006 Practice Management Survey as Canadian GPs' biggest practice complaint. Twenty-nine percent identified ever-growing mountains of paperwork as their most pressing practice concern. Respondents report being buried beneath a veritable avalanche of lab reports, specialist referrals, dictation corrections, patient record transfer requests, prescription forms, government forms, insurance reports... the list goes on and on.

PAPERWORK WOES
Recent studies have shown that physicians' paperwork burden is on the rise, and that it's not only other aspects of your work that suffer as a result, so can your job satisfaction. A survey conducted by two Ontario doctors in the journal Canadian Family Physician in May found that the physicians in their rural family practice handled an average of 335 pages of paperwork each week — that adds up to a staggering 17,000 pages per year.

This deluge of forms and faxes can understandably cause quite a strain on you. "There is certainly a lot of paperwork in family practice," affirms Dr Holdway. "It's the nature of the beast. That's how it is."

Dr D'Souza has seen her fair share of problems as a result of paperwork overload. In one instance, she received a letter from another paper-swamped doctor that read, "I leave this decision to your desecration," an unfortunate typo for discretion. Luckily that wasn't a serious error — like identifying the wrong surgery site or mixing up the names of drugs, for example — but she admits it can be incredibly time-consuming to double-check all of your correspondence and reports when the stack of papers on your desk is growing out of control.

WHAT YOU CAN DO
Although paperwork is an integral part of your job, there are some things you can do to relieve its choke-hold on your schedule — besides taking speed-reading lessons.

"It's very important to have an efficient secretary," says Dr D'Souza. "When they're not efficient, it's really laborious for you to catch their mistakes."

Another option is to switch to electronic medical records to try to reduce the amount of paper cluttering your office. Dr Holdway's group practice has done so, and now owns a network of about 50 computers. The computer system allows him to access much of his work from home so he can complete forms over the weekends or during the evenings. The system also allows him to automatically transcribe his dictation into text using speech recognition software. Dr Holdway admits it is not a perfect solution—secretaries have to type out information faxed from hospitals or other doctors, and his voice recognition software recently crashed and now needs to re-learn his speech patterns and medical jargon — but computerization can help, he insists. "We do have problems with it on a weekly basis, but it's better than paperwork," he says. "We never lose charts, and it's easier to print off charts to send when a patient moves, for example."

OTHER CONCERNS
Closely following paperwork on your list of your most pressing practice concerns was your overall workload, earning the ire of 22% of doctors overall. Those two problems accounted for nearly half of your (GPs and specialists combined) responses. But the remainder of you reported a wide variety of worries.

The inability to take on new patients is the top worry of 13% of GPs, while finding good staff was close behind at 12%.

Computerization and its many challenges — such as learning how a new system works, training staff, and transferring records from paper to digital — and the volume of geriatric patients, typically a difficult demographic to work with, tied at 3.7%. It is interesting to note that as paperwork became the number one concern of doctors this year, rising from second place in last year's survey, computerization increased significantly as a concern. This may indicate that as paperwork becomes more of a struggle for doctors, more and more of you will make the move to electronic medical records.

Several other practice concerns were mentioned by 2% of you or less, including incorporation, dealing with drug seekers and buying your own practice.

GP/SPECIALIST DIVIDE
About five times as many GPs responded to the 'most pressing practice concern' question as did their specialist colleagues. GPs and specialists agreed on some matters, but in many cases their opinions diverged sharply.

For example, GPs tended to find paperwork to be more tiresome than specialists did. More than twice as many specialists complained of their overall workload compared to GPs.

But perhaps most surprisingly was the issue of wait times. Only 2.2% of GPs who responded to our survey said that was their biggest problem, while it was far and away the biggest problem for specialists, at 36%.