Physicians Frustrated By Administrative Burdens of Medical Practice

By Marie Benz, M.D., Oct. 23, 2014

Interview with Steffie Woolhandler, M.D., M.P.H., Professor of Public Health and City University of New York, Lecturer (formerly Professor of Medicine) at Harvard Medical School, Primary Care Physician Practicing in the South Bronx.

Medical Research: What is the background for this study?

Dr. Woolhandler: Physicians like myself are extremely frustrated by the administrative burdens of medical practice. Many hours of physicians’ time each week go to administrative work completely unrelated to good patient care, but mandated by private insurers and other payers. Colleagues often tell me that they love seeing patients but are getting burned out by the paperwork.

Medical Research: What are the main findings?

Dr. Woolhandler: We found that the average practicing U.S. physician spends 8.7 hours per week, 16.6 percent of his or her working hours, on non-patient related paperwork. (This figure excludes time spent writing progress notes, communicating with other doctors, or ordering tests, which we considered patient-related work. However, it includes billing, obtaining insurance referrals, financial and personnel management, and contract negotiations). Pediatricians spent the least time of any specialty on paperwork (14.1 percent of their work week) and psychiatrist the most (20.3 percent). Spending more time on paperwork significantly reduced physicians’ career satisfaction. Overall, U.S. physicians spent 168.4 million hours on paperwork in 2008, at an opportunity cost of $102 billion in lost patient-care time.

Unfortunately, many ongoing changes in medical practice are likely to increase, rather than decrease doctors’ administrative burden. For instance, physicians are moving into large group practices, but physicians in such practices actually face more paperwork than those in small groups. Similarly, electronic medical records are associated with a higher share of physicians’ working hours being devoted to administration.

Medical Research: What should clinicians and patients take away from your report?

Dr. Woolhandler: Physicians, patients and policymakers need to be advocating for a payment system that lets doctors spend their time on patients, not administration. This means switching to a simple, single payer system, that is, non-profit, tax-funded national health insurance. Private health insurance firms not only generate their own byzantine and expensive bureaucracies, but impose huge bureaucratic burdens on patients and physicians.

Medical Research: What recommendations do you have for future research as a result of this study?

Dr. Woolhandler: Patients and families also face a huge bureaucratic burden dealing with insurance enrollment, copayments, deductibles, referrals and finding doctors in the “narrow networks” that private insurers increasingly impose. Virtually no research has assessed the time spent by patients on such tasks. In addition, there has been no recent research on the amount of time spent by doctors in single payer systems such as Canada’s on paperwork, although anecdotally, physicians there report very little administrative work and relatively high career satisfaction.

Citation: “Administrative work consumes one-sixth of U.S. physicians’ working hours and lowers their career satisfaction,” Steffie Woolhandler, M.D., M.P.H., and David U. Himmelstein, M.D. International Journal of Health Services, Vol. 44, No. 4.

Marie Benz, M.D., F.A.A.D., is a physician in practice over 30 years. She is editor of