Fredericton family doctor calls on province to help cut paperwork, free up time for patients

If the New Brunswick government would help cut paperwork for family doctors, they could see their patients sooner and might be able to take on more patients, says a Fredericton doctor.

It could also reduce doctor burnout and help encourage new doctors to get into family practice, said Dr. Will Stymiest.

About 59,000 New Brunswickers are registered as not having a family doctor.

Stymiest estimates he spends four to eight hours a week on paperwork.

That includes "essential" things that won't change, such as documenting patient visits, billing Medicare, and making sure office staff are paid, he said.

But there are also numerous forms, such as the extra documentation required for provincial coverage of certain medications, and sick notes required for public sector employees.

"If the government was able to eliminate or consolidate, even simplify some forms, that would go a long way to reducing the paperwork burden that we have," said Stymiest.

10% cut equal to 119,726 patient visits

According to a new study by the Canadian Federation of Independent Business, eliminating "unnecessary administrative work" for New Brunswick doctors would be the equivalent of adding 152 doctors.

Even just a 10 per cent cut in their paperwork would free up enough of their time to provide 119,726 extra patient visits, according to the study, Patients before Paperwork, released earlier this week.

Across Canada, the study says about 55.6 million patient visits are lost each year because physicians are spending a combined 18.5 million hours on unnecessary administrative tasks — time that could be better spent with patients.

The organization wants provincial governments to follow the lead of Nova Scotia, which last year set a target to reduce the physician administrative burden by 10 per cent by 2024, with the goal to free up 50,000 hours of physician time a year — the equivalent of 150,000 patient visits.

A review by the New Brunswick Medical Society found there are up to 40 forms the Department of Social Development requires to be completed by physicians, according to Stymiest.

Of those, he contends only about three actually require a physician to complete them, while the rest could be completed by someone else, such as a pharmacist. Some, he said, are "unnecessary."

He cites as an example a diabetic patient with a Social Development health card who requires a form every year to say she requires insulin and has to check her blood sugar levels, and that those are medically necessary expenses for her to have covered by the department.

"I think for a lot of us, if we had, you know, magically tomorrow 10 to 15 per cent less paperwork and therefore hopefully more time to spend with patients, we might actually look at taking on new patients into our practices," said Stymiest.

"And I think this is a source of burnout and frustration for family doctors and it, you know, probably leads to people not having a community practice, or never entering family medicine at all."

Medical society 'strongly supports' reducing paperwork

The New Brunswick Medical Society strongly supports measures aimed at reducing the burden of excessive paperwork and other administrative duties performed by physicians, said president Dr. Michèle Michaud, a family physician, palliative care physician, pain clinic physician and hospitalist in Edmundston.

"Paperwork is a major issue both in terms of workload and physician burnout," she said in an emailed statement.

"Physicians report spending more time on administrative duties than patient care, with the skew continuing to grow thanks to the increased need to document everything thoroughly, and often in duplicate, for insurance, legal, and billing purposes.

"Streamlining these processes would help relieve strain on physicians and give them more time to focus on seeing patients."

Department of Health open to discussion

Spokesperson Adam Bowie said the Department of Health supports efforts to reduce the administrative burden on the province's physicians and is "open to discussing with the New Brunswick Medical Society what it can do to help reduce the volume of unnecessary paperwork physicians are required to complete.

"It should … be noted that the paperwork physicians complete is important, as medical forms are often used for approving leaves of absences, long-term disability claims, and requests for equipment," Bowie said in an emailed statement.

WorkSafeNB, insurance companies, the federal and provincial governments and various other organizations may require physicians to complete forms so they can offer individuals access to programs, benefits or funding, he said.

Group practices, e-records urged

"The department has been encouraging physicians to transition to group-based, collaborative practices, and to adopt electronic medical records in recent years," as ways to help, said Bowie. "That direction will continue in the years to come," he said.

As it stands, "many" New Brunswick physicians operate solo, fee-for-service practices, he said, which means they are often supported solely by a medical administrative assistant.

Meanwhile, about half of the province's family doctors still use paper records, which means they're missing out on the efficiencies offered by electronic medical records, said Bowie.

For example, to make it easier for physicians to bill Medicare, doctors are now able to submit electronic payment claims directly from their electronic medical record software, he said.

"We have seen some progress in recent years, as many newly trained physicians are embracing new medical technology."

The Department of Social Development did not respond to a request for comment.

Calls for help to hire office nurses

Another way the government could reduce the paperwork burden, said Stymiest, is to help doctors hire more licensed practical nurses or registered nurses.

They are well-trained providers and can help with parts of patient visits, he said. They can also help with some of the documentation of patient visits.

Stymiest, who shares an office with three other doctors, including his wife, has a nurse who helps gather some of the background information for forms, which frees him up to see more patients before he needs to rush out at the end of the day to pick up his two young children from daycare.

He believes he's "in the minority." But if more doctors could hire nurses in their offices, "we would start to see better health outcomes, because nurses certainly contribute to that, but also better access in offices, and maybe physicians will be able to take on more patients," he said.