Sick of sick notes: Doctors say scrapping paperwork would save time better spent on patients
Some provinces limiting ability of employers to demand sick notes to free up doctors' time
The Cure is a CBC News series examining strategies provinces and territories are using to tackle the primary care crisis.
With Canada currently in the depths of the cold and flu season and COVID continuing to spread year round, frustrated doctors say they don't want to waste time writing notes to excuse people from school or work.
In fact, most doctors across the country want sick notes for minor illnesses eliminated altogether.
"Come on people, these are grown-ups," said Dr. Rita McCracken, a family physician and primary care researcher based in Vancouver. "If they have a cold and they are spewing germs and they're making a good call to stay home from work, they don't need to bring those germs into my office to get a note so that you can feel better about them not coming to work."
An estimated 6.5 million Canadians don't have access to primary care, and a separate report from Health Canada estimates the country needs 23,000 family doctors to fill the gap.
Doctors in Canada wrote about 12.5 million sick notes last year, according to Dr. Joss Reimer, president of the Canadian Medical Association. She says eliminating sick notes could allow the doctors we do have to care for more people and make their practices more efficient.
How do you think policies around sick notes and medical forms should change? Share your thoughts via email at ask@cbc.ca
"Our family docs spend between 10 to 19 hours a week on paperwork," Reimer said, adding that things like filling out forms and writing sick notes is exhaustive work that takes them away from seeing patients, which is what they're trained to do.
Some provinces are making moves to curb the use of sick notes.
In Nova Scotia, employers can't demand a note unless a worker has been off sick for more than five consecutive days. Saskatchewan has similar legislation pending. In Ontario and Quebec, it's three days.
Newfoundland and Labrador removed provisions in the Labour Standards Act that required notes after three days, however, employers in that province are still free to create their own sick leave policies.
Piles of paperwork, electronic records
But sick notes aren't the only aspect of paperwork doctors say they're drowning under.
"In an average week, I'm probably spending four to eight hours doing paperwork," said Dr. Steve Major, a family doctor in St. John's who is also the president of the Newfoundland and Labrador Medical Association.
He says that includes disability forms, disability tax credit forms, Canada pension forms and lawyer reports. The disability tax credit forms are the most cumbersome because he says they can range from 14 to 16 pages.
Major says all this paperwork usually has to wait until he has time on the evenings or weekends.
"That's another reason that some people don't want to choose family medicine, because of that administrative burden."
He says making changes to allow doctors to certify paperwork that's already been largely filled out by patients could improve the process and result in more doctor-patient time.
Maria Mathews, the Canada Research Chair in Primary Health Care and Health Equity at Ontario's Western University, says electronic medical records can, counterintuitively, increase the administrative burden doctors face.
"You actually have to type in different forms," she said. "And we hear stories of family physicians saying, you know, the form got dumped back to me because this part wasn't filled right, so it takes a lot of back and forth. It's not a streamlined process."
Mathews, who is also a professor in the Department of Family Medicine at Western, says medical records often aren't easily shared, either between doctors or hospitals.
This creates a lot of additional work that she says could be eliminated by standardizing referral processes and forms for each laboratory or imaging facility.
McCracken says such standardization would cut down on the number of forms she has to sort through for common diagnostic exams, like the ones she needs to fill out when sending a patient for an x-ray, for example.
"There's not just one form that I can fill out on my electronic medical record … there's about 300. Each imaging facility has their own," McCraken said, adding that asking doctors to sort out all of those forms is "preposterous."
Task forces, legislation aim to cut paperwork
Nova Scotia and Manitoba have established task forces to eliminate and streamline paperwork.
Nova Scotia estimates it has saved doctors more than 282,000 hours of administrative work by updating processes including technology, improving legislation, expanding the scope of practice for other health-care professionals and eliminating or improving forms.
The province is now setting its sights higher, aiming to reduce time spent on red tape by 400,000 hours each year.
Manitoba's task force reported last fall that its Burden Reduction Playbook has saved doctors in that province 75,300 hours of unnecessary administrative work annually.
Quebec's new bill aimed at curbing sick notes and reducing administrative tasks came into effect this year. Some measures have yet to be implemented, but when in force, they will ban private insurance companies from asking for doctor's notes for reimbursements related to medical accessories and health treatments, like physiotherapy or massage therapy.
The provincial health minister has said the move could free up an estimated 300,000 to 500,000 doctor's appointments annually.
Mathews says the key to moving forward is tracking which strategies are working when it comes to lowering the administrative burden on doctors. She says electronic medical records can be looked to as a cautionary tale.
"There are new technologies coming in that we kind of really assess, is this helping," she said. "And if not, how do we tweak it?"
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