Filling out forms, chasing results, completing referrals, Connect Care duplication, Facilitated Access to Specialized Treatment (FAST) processes, clinical pathways, and regulatory college requirements: these are just some of the tasks identified by family physicians and rural generalists as contributing to the increasing administrative burden in longitudinal comprehensive family medicine practices in Alberta.
In October of 2023, the Alberta College of Family Physicians (ACFP) and the Alberta Medical Association (AMA), Accelerating Change Transformation Team (ACTT) were tasked by Alberta’s Minister of Health, the Honourable Adriana LaGrange, to identify short-term strategies to reduce the administrative burden of family physicians and rural generalists. Using a multi-modal approach, the working group gathered information from frontline physicians through a survey, which garnered 766 responses, three focus groups with 21 participants, and 14 key informant interviews. The focus groups and key informant interviews allowed the project team to understand the root causes, trends, and structures that are contributing to the increasing administrative tasks and burden in primary care. This information coupled with a literature review and work from other provinces led to a report with 16 specific recommendations to immediately alleviate the administrative burden on community providers and was submitted to the Minister of Health in January 2024.
What Did the Project Team Find?
The survey results showed an average administrative task time burden of 15-20 hours per week for people practising longitudinal comprehensive family medicine. Respondents reported that they are doing these tasks, outside of regular clinic hours, primarily in the evening and weekends. They reported on average, 40% of the tasks were unnecessary or could be done by others.
The excessive administrative tasks are impacting patient’s access to providers, as physicians reduce their clinical hours and appointment slots to try to balance this work with patient care and their other responsibilities outside of medicine. The impact on physicians is very troubling with 96% of physician respondents finding the administrative task burden is affecting their work-life balance, 97% are finding it affects the enjoyment of work, and 80% are looking at leaving longitudinal comprehensive primary care for other work in the health system (Hospitalists, focussed practices), or retiring early.
Administrative burden has been identified as one of the key drivers of burnout in family physicians. The tasks are often unremunerated, are of low clinical value, and take time away from seeing patients. Family physicians feel that other parts of the health system often place unnecessary pressure on their practices, and they feel overwhelmed with administrative burden and paperwork related to care of their patients.
Five Areas Requiring Immediate Action
After reviewing the rich comments on the survey, the robust discussions with the focus groups and the key informant interviews, the working group identified five areas where immediate actions on administrative burden could be targeted:
- System and Structural drivers
- Forms and Letters
- Optimizing Team-Based Care
- Patient Education, Professionalism, and Regulation
- Compensation Strategies
Sixteen recommendations were developed. These include the elimination of sick notes from employers, appropriate payment for forms required for patients to access to social programs, simplification of Assured Income for the Severely Handicapped (AISH) forms and working with Alberta Blue Cross to develop an “opt in” program for common medications requiring special authorizations. A recommendation for team members that could support administrative tasks being done by physicians, as well as appropriate compensation for administrative work will be essential in dealing with this problem.
The issues with Connect Care for providers working in community is a complex problem and needs priority funding to fix. Recommendations for resources to look at interoperability between community EMRs and Connect Care and dealing with privacy legislation to allow flow of information to community providers in their clinics and Primary Care Network (PCN) programs were also a priority.
The specific recommendations are available here.
So, What is Happening Now?
When the Minister announced the Supporting Comprehensive Care Task Force, she committed to move forward with solutions to address administrative burden as quickly as possible. The Task Force has provided the Minister with recommendations and discussions have been initiated to explore solutions that require collaboration between Alberta Health and other parts of government. High-level proposals for work on interoperability for EMR’s in community and Connect Care have been presented as well as proposals to initiate discussions regarding the Health Information Act and the Office of the Privacy Commissioner to allow more seamless flow of information throughout the system.
The Task Force proposed a Program Management Office to continuously assess administrative burden in health care as part of a long-term solution. The exploration of Artificial Intelligence to alleviate some of this burden, along with patient education, review of standards of care with regulatory colleges, new payment models that address the administrative work in practice must considered as we address this problem in the future.
The administrative burden of physicians, especially those who practice in longitudinal comprehensive family medicine must be addressed. The report submitted is just the beginning of the work ahead. The ACFP and AMA ACTT are committed to continuing to explore solutions and eliminate unnecessary tasks from family physicians and rural generalists’ day so they can do the work they enjoy and are trained to do, seeing patients and their families, and supporting their communities. In addition, it is imperative that administrative burden does not continue to impact evenings and weekends that should be spent for personal time with family and friends and for a healthy lifestyle.
