On June 6, federal legislation was introduced in Canada that would establish common standards for sharing information and offer patients and their providers easier access to health data.

The proposed change is one of several initiatives aimed at reducing the administrative burden that healthcare providers face. Canadian physicians spend roughly 18.5 million hours each year on unnecessary administrative work, according to a 2023 report from the Canadian Federation of Independent Business. That time is equivalent to 55.6 million patient visits. Another report from a Manitoba task force estimated that 44% of the time its doctors spend on paperwork is unnecessary.

“It’s really distressing anytime I get an overly complicated or unnecessary form on my desk,” Randy Guzman, MD, president of Doctors Manitoba and a vascular surgeon at St. Boniface Hospital in Winnipeg, Manitoba, Canada, told Medscape Medical News. “Of course, we as physicians complete the form because our patients need it to get care or to get a benefit. But as I spend the time filling it out, I’m thinking about the next patient I’m making wait, or the extra patient I could have seen today.”

Some provinces, including Manitoba, have already made progress in reducing this administrative burden. As of September 2023, Nova Scotia saved an estimated 200,000 hours per year with its initiatives, and more steps are underway.

Reducing Unnecessary Tasks

Foundational inefficiencies in the healthcare system are being targeted — including in data sharing, the target of the proposed federal legislation. But most initiatives so far have focused on easy wins, such as removing unnecessary forms and streamlining others, according to Guzman. For example, a major source of physicians’ administrative work comes from outside the health system. Examples include requests from employers, insurance companies, and government benefit programs, he added.

Eliminating sick notes, which permit Canadians to take time off work for short-term illness, has become a particular focus. Often, physicians must fit patients into their schedules to provide these notes, which takes time away from patients who may need more substantial care. In fact, the Ontario College of Family Physicians estimates that family doctors spend 261,000 hours each year managing sick notes.

Getting rid of sick notes is one of the Canadian Medical Association’s recommendations for reducing the administrative burden, and several provinces have taken steps toward this goal. The Ontario government recently eliminated the requirement for sick notes for employees who take off fewer than 3 days of work, and Doctors Manitoba received a grant to focus on eliminating or simplifying these and other third-party requests.

‘Pajama Time’ Paperwork

Excessive time spent on administrative tasks is also a significant factor contributing to the shortage of primary care providers and widespread burnout.

“Our healthcare system is facing a crisis,” said Mekalai Kumanan, MD, president of the Ontario College of Family Physicians. In Ontario alone, more than 2 million people lack access to a family physician, Kumanan noted. “We have to take all of the steps that we can to address it, which means freeing up time away from paperwork and allowing family doctors to spend more time with their patients.”

Family physicians spend a lot of time helping patients access different parts of the healthcare system, including making referrals and retrieving diagnostic imaging. This type of administrative work is necessary, but the connections between parts of the healthcare system are often difficult to navigate. “We’re sometimes seeking referral after referral just to get one service for our patients,” said Kumanan. “It’s really the inefficiencies in the system that take the biggest toll on us.” She believes that changes like introducing a centralized referral system, for example, could help.

The large amount of paperwork that family physicians and other providers must complete often bleeds into personal time, further contributing to burnout. “For a while, they were affectionately calling it ‘pajama time’ because it was time that we spent after hours,” said Kathleen Ross, MD, president of the Canadian Medical Association and a family physician in British Columbia. “We’d have to sit down to a mountain of electronic paperwork at the end of the day, oftentimes in our pajamas or on a weekend.”

Artificial Intelligence (AI) Aides

Additional inefficiencies introduced by electronic medical records are a “ubiquitous” challenge for all doctors, noted Ross. While these systems were expected to cut down on administrative time when first introduced, they instead added time. In one hospital in British Columbia, productivity dropped by 50% when an electronic record system was introduced, Ross said. More than a year later, the hospital is still at 80% of the previous clinical workflow. “We’ve become data entry clerks in many of these systems. We need to find our way back out of that quagmire,” said Ross.

AI tools may provide one strategy for reducing the time spent on this type of administrative work. In Ontario, a pilot program of 150 clinicians is testing AI scribes that would help summarize patient visits and potentially cut down on the time providers spend charting at the end of the day. Some physicians also said that the program allows them to engage better with patients, according to Kumanan.

Having a tool to automate notes and data entry could be “a ‘died-and-gone-to-heaven’ aide for those of us who are seeing 40 patients a day and having to manually transcribe all the data,” said Ross. But, she added, AI should be approached with caution and always with patient consent. “There’s a lot of unanswered questions at the moment that we need to balance against the urgent need to address the administrative burden that physicians face.”

Gwendolyn Rak is a health reporter for Medscape Medical News based in Philadelphia.