Family doctors in P.E.I. have recently been voicing concerns about their growing administrative workload, and experts say addressing the issue will require a range of changes.
The concern comes amid months of tension between front-line health workers and Health P.E.I.
One boiling point has been the provincial health authority’s rollout of the Physician Services Agreement — the province’s contract with doctors. Physicians say its implementation could increase their administrative burden, contribute to burnout and cut into their time with patients.
Dr. Hendrik Visser — a retired family doctor who spent years practicing in Africa and ran his clinic for 32 years in Crapaud, P.E.I., — said the issue is widespread. He has heard from some clinicians who spend several hours each day on administrative tasks.
“The administrative load that is being put on them is excessive,” Visser told This is P.E.I. host Mitch Cormier.
That experience is not unique to P.E.I.
Doctors across Canada each spend an average of nine hours per week on administrative tasks, totaling 42.7 million hours annually across the country, according to a recent report from the Canadian Medical Association and the Canadian Federation of Independent Business, which surveyed 1,924 physicians.
While more than half of that work is considered necessary — referrals and reviewing test results — nearly half (47 per cent) is seen by doctors as unnecessary red tape. This includes tasks like filling out disability tax credit forms, Canada Pension Plan paperwork, sick notes and insurance forms.
“All of those come across the desk of a family physician, and when they have to complete that, often after hours or typical work day hours, this causes them to spend that time and takes away from caring for patients or takes away from work-life balance,” said CMA president Dr. Margot Burnell, an oncologist.
Burnell says one solution is better delegation. She said some forms and administrative tasks could be handled by other trained health professionals who understand the patient’s condition.
Visser agrees, pointing to his own experience.
“In my own practice in Crapaud … I equipped and trained my [registered nurse] to do a lot of that reviewing of lab results, of incoming consults, and helping decide where action was needed,” he said.
“By delegating and dividing the load with a team, it’s possible to to reduce that load.”
But that team-based care requires trust.
“I needed to trust my nurse that she wasn’t going to put me at medical legal risk by missing something,” Visser said. “I learned to trust her because she was consistent and reliable. Likewise, she would trust me to act on any flags that she raised where action was needed.”
That teamwork allowed his clinic to manage a patient panel of about 2,300 people.
Visser said training on delegation should start early, even during medical residency, so new doctors learn how to manage clinic workflows and work effectively in teams.
Health P.E.I. officials pitched the benefits of patient medical homes to MLAs at a legislative standing committee on Friday. But politicians wanted to know why the number of Islanders who need a doctor is not going down, even as the province rolls out more of the homes. CBC’s Wayne Thibodeau explains.
Another major driver of administrative burden is Islanders’ limited access to primary care.
When patients can’t get timely appointments, they may turn to emergency rooms, which Visser said can create more work later for family doctors. For example, a parent with a sick child who can’t reach their doctor may go to the ER a few days later when the condition worsens.
“Then the paperwork that comes back from the ER visit is extra workload on the primary care clinician’s office,” he said.
“It’s created a backlog of extra work because that mother wasn’t able to be reassured that very first day that this child is going to be OK or maybe does need treatment.”
He suggests clinics could set aside daily urgent appointment slots with non-physician providers, such as nurse practitioners or physician assistants, to help reduce that backlog.
Visser said another factor is the narrowing scope of family medicine.
Over time, he said, more services such as diagnostic imaging, lab work, procedures and specialist care have been outsourced. That means more forms, referrals and followups for family doctors.
“All of those procedures that are outsourced, it comes with extra paperwork … because the family doctor is the one who gathers the whole medical record.”
He said expanding team-based care could help free up doctors’ time and allow them to expand their scope of practice.
“They could … take more time in researching difficult cases without having to refer the patient to a specialist to confirm their diagnosis,” Visser said.
At his Crapaud clinic, Visser’s team handled many procedures themselves that are now outsourced, such as excisions and stitching.
Visser cited overdiagnosis — the detection of a conditions that may be normal parts of aging and may never pose any health risks during a person’s lifetime — as a another contributor to administrative workload.
He said one example could be an MRI of a 40-year-old’s back showing changes suggesting degenerative disc disease.
“The word ‘disease’ implies that that spine is sick, whereas it’s like my grey hair. It’s not a disease, but it is a sign of aging,” Visser said.
“I’m not going to order surgery for my grey hair, but people may order more tests or injections or other interventions for that grey spine.”
He pointed to Choosing Wisely Canada, an initiative launched more than a decade ago to reduce unnecessary tests and treatments.
Improving clinic workflows and the use of technology could also boost efficiency, Visser said.
But he stressed that leadership matters most, especially amid tensions between Health P.E.I. and front-line workers.
“We need to have all stakeholders together around the table to really listen to each other and find solutions,” he said.
The Canadian Medical Association report outlines a number of recommendations beyond delegation.
They include getting rid of sick notes, implementing AI scribes in doctors’ offices to provide summaries of care, simplifying and streamlining insurance and tax forms, and providing paid time to do administrative work so doctors aren’t doing it on personal time.
Burnell says the CMA is already working with stakeholders to implement some of these changes.
Several provinces have passed legislation limiting when employers can demand sick notes. Many heath-care clinics are using AI scribes, often in government pilot programs to test accuracy and cybersecurity.
The CMA is working with the Canada Revenue Agency to simplify paperwork for the Canada Pension Plan Disability and the Disability Tax Credit and — two forms doctors identified as the most notoriously difficult and time-consuming. The latter is 15 pages long, and can’t be submitted by email.
“It will take multiple approaches to improve this,” Burnell said.
