Thursday, October 23, 2014
International Journal of Health Services
Volume 44, Number 4 / 2014
Administrative Work Consumes One-Sixth of U.S. Physicians' Working Hours
and Lowers Their Career Satisfaction
By Steffie Woolhandler and David U. Himmelstein
Doctors often complain about the burden of administrative work, but few
studies have quantified how much time clinicians devote to
administrative tasks. We quantified the time U.S. physicians spent on
administrative tasks, and its relationship to their career satisfaction,
based on a nationally representative survey of 4,720 U.S. physicians
working 20 or more hours per week in direct patient care. The average
doctor spent 8.7 hours per week (16.6% of working hours) on
administration. Psychiatrists spent the highest proportion of their time
on administration (20.3%), followed by internists (17.3%) and
family/general practitioners (17.3%). Pediatricians spent the least
amount of time, 6.7 hours per week or 14.1 percent of professional time.
Doctors in large practices, those in practices owned by a hospital, and
those with financial incentives to reduce services spent more time on
administration. More extensive use of electronic medical records was
associated with a greater administrative burden. Doctors spending more
time on administration had lower career satisfaction, even after
controlling for income and other factors. Current trends in U.S. health
policy—a shift to employment in large practices, the implementation of
electronic medical records, and the increasing prevalence of financial
risk sharing—are likely to increase doctors' paperwork burdens and may
decrease their career satisfaction.
From the Discussion
A few studies have examined the amount of time physicians spend on
billing and insurance-related paperwork—a narrower definition of
administrative work than we used. A 2000 California study estimated
billing and insurance-related work consumed 4.9 percent of physician
time. In a 2006 survey, physicians reported spending 3 hours per week
interacting with private insurance plans, with primary care doctors and
solo practitioners reporting slightly higher figures; 81.5 percent
perceived that this work was increasing. A companion 2006 survey of
office-based private practitioners in Ontario found they spent 2.2 hours
per week interacting with insurers (vs. 3.4 hours in the United States
when Medicare and Medicaid were included along with private insurers).
Differences in the time spent on these tasks by non-physician office
staff were even larger; 20.6 hours of nurse time per physician in the
United States versus 2.5 hours in Canada; 53.1 hours per week of
clerical time in the United States versus 15.9 hours in Canada; and 3.1
hours per week of senior administrators' time in the United States
versus 0.5 hours in Canada.
Much time and money are currently spent on medical billing and
paperwork. A simpler system could realize substantial savings, freeing
up more resources to expand and improve coverage.
International Journal of Health Services (click on the article for the
PNHP Press Release:
Comment by Don McCanne
The health care system in the United States is unique for its profound
administrative waste. This article by Steffie Woolhandler and David
Himmelstein demonstrates the intensity of the administrative burden on
physicians - a burden that is correlated with lower career satisfaction.
The good news is that we could reduce that burden and improve
satisfaction by adopting a single payer system such as they have in
Canada. But then the bad news is that we have left the political agenda
in the hands of those who are adept at buying the votes in Congress -
especially the insurance and pharmaceutical industries.
It doesn't have to be this way. After all, we are a democracy, but we
have to make the effort to have our voices heard.
U.S. Department of State
Bureau of International Information Programs
What Is Democracy?
The essence of democratic action is the active, freely chosen
participation of its citizens in the public life of their community and
nation. Without this broad, sustaining participation, democracy will
begin to wither and become the preserve of a small, select number of
groups and organizations.
At a minimum, citizens should educate themselves about the critical
issues confronting their society--if only to vote intelligently for
candidates running for high office.
at 1:01 PM