TORONTO | Dr. Yoel Abells loves interacting with patients, delivering babies and providing care, but there is one aspect of this family physician’s job he calls “terrible.”

“If I ever gave up medicine it would be because of the paperwork,” said Dr. Abells, medical director of the Forest Hill Family Health Centre in Toronto. “I am tired of looking forward to the weekend so I can get caught up on my paperwork.”

The results of the 2007 National Physician Survey show Dr. Abells is not alone. Fifty-seven per cent of family physicians and 34% of other specialists reported paperwork was a “major impediment in delivering quality health care to their patients.”

It was also second only to on-call responsibilities as an item causing stress.

Here are some tips to ease the burden of paperwork:

1. Time management

Rick Jamison, national director of consulting for Practice Solutions, a CMA company, suggests physicians leave hours expressly for administrative tasks without booking patients. He tells physicians to deal with an item within a week of receiving it.

“It’s not efficient to pick it up 10 times or always have it in the back of your mind,” he said.

Dr. Kishore Visvanathan, division head of urology in the Saskatoon Health Region, says if some tasks bother you, don’t keep repeating them.

“Take the time once to fix it,” he said.

For example, in his practice, a common prescription that is quite lengthy was typed out and photocopied for re-use. Prescriptions for some drugs are pre-printed.

A folder containing all requisitions, along with paperwork for booking surgery, helps him complete the paperwork just after he’s seen a patient, saving him from reviewing them later. It also gets the form into the surgery booking office three to five days faster.

Trudy Pelletier, a certified executive coach at Simply More, a management training firm in Calgary, suggests logging activity for a week to get a clear picture of where your time is going and to see what tasks need more or less focus. Then take the time to plan.

“Very few people plan their time so they move from fire to fire or pile to pile without determining how important or non-important the task is,” she said.

She suggests dividing administrative time into blocks to perform one task at a time. For example, schedule two blocks to respond to e-mail and two blocks to return phone calls. “Remain focused on that task until the time you allotted for it is up.”

2. Electronic medical records

“In cutting down on paperwork, EMRs lead the pack,” Dr. Visvanathan said. “I am no longer tied to paper records at the office. You often have 45 minutes to an hour between surgeries where you are sitting down, frustrated, twiddling your thumbs because you know work is piling up. Now I can make calls and fill out forms between surgeries. This saves me 30 to 60 minutes at my desk every day, no question.”

Jamison points out electronic records also make filling out forms easier, as a physician can go through and cut and paste the information.

3. System changes

Dr. Abells said some relief will need to come from outside the office. He said paperwork is sometimes unnecessary—for example, when schools ask for a note from the family doctor allowing a child to take Tylenol.

“Parental permission should be adequate,” he said.

Dr. Abells noted health benefits, for example, such as massage and physiotherapy, should not require a note from a physician, but should come from the person providing the service.

He also said the college of physicians and surgeons should also take a strong stand regarding insurance companies’ and lawyers’ expectations of physicians, citing one time when he prescribed support stockings for a patient. The insurance company sent him a letter with seven questions, including asking the size of the patient’s veins.

“If the college wants us to attend to more patients, attend better to patients, get involved in policy-making decisions and hospital committees, there should be some sort of consensus as to what’s reasonable in quantity,” Dr. Abells said, suggesting provincial colleges negotiate with insurance companies regarding expectations and standardization.

4. Proper compensation

Jamison says doctors need to get paid properly for paperwork.

“In some cases they are making $25 for an hour’s work. If they are paid properly, it won’t seem like so much of a burden,” he said, adding physicians should follow provincial medical associations’ fee recommendations. “Sometimes, doctors think it will be quick and don’t bother charging. But a mechanic or a plumber wouldn’t do the work and not charge.”

5. Delegate

Other staff members can perform tasks such as keeping statistics or patient information, Jamison said. He noted a computerized template for form letters is a good idea.

Dr. Visvanathan said anything that is done often and doesn’t require the physician should be standardized.

For example, although it is important to the patients, phoning them about their post-vasectomy test results doesn’t always take priority over other phone calls, such as biopsy results. So his office created a letter showing “all clear” test results. Staff make up the letter and show it to the physician, who confirms the test result before signing the letter. The only function demanding physician attention is confirming the result.

Dr. Visvanathan also recommends a team meeting. “Staff gave us great ideas. They are the experts of flow in your office,” he said.

6. Change your mindset

Pelletier suggests linking paperwork to patient care.

“Get clear on how the paperwork helps the patient receive care. For example, when a patient receives insurance payments, it affects their well-being from a stress perspective, it helps their household finances, it probably affects family relationships.”