The workday for internist Jeffrey Kagan, MD, doesn’t end when he leaves his Newington, Connecticut, office. He still has two to three hours of unpaid work ahead of him reviewing lab reports, X-rays and MRIs, as well as returning phone calls.
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Kagan says he spends 12 to 17 hours weekly on tasks for which he receives no compensation. This includes the work he performs each evening at home, plus unpaid tasks throughout the day, such as prior authorizations for insurance companies and research to identify the latest clinical treatments and closest centers of medical excellence that could potentially benefit his patients.
“It’s not unusual for me to leave the office around 7 p.m. because I’ve had enough, come home and eat dinner with my wife, and by 8 p.m. I’m on the computer,” he says. “I’m there through the 11 o’clock news.”
Like many physicians, Kagan uses personal time to complete tasks necessary to keep his practice running efficiently. To some degree, physicians have always done this. However, anecdotal data suggests that physicians are spending even more of their time on uncompensated tasks than they ever had in the past.
Is this pattern of uncompensated time simply the “new norm” in today’s practices, or can physicians somehow reign in these tasks for a better work-life balance?
Uncompensated time continues to increase
Physicians spend a significant amount of their workdays—probably 20% or more—on uncompensated tasks thanks to a barrage of regulatory requirements, says Joseph Valenti, MD, a board member of the Physicians Foundation, a nonprofit physician advocacy group.
This equates to at least $50,000 of lost revenue per physician annually, says Valenti. Four years ago the Physicians Foundation Biennial Physicians Survey found that it was $25,000, and that figure has easily doubled in the last four years, he says.
Nitin Damle, MD, MS, FACP, president of the American College of Physicians (ACP), says the lost revenue associated with uncompensated tasks could be even higher—closer to $60,000 annually per physician. This includes the time spent on uncompensated tasks as well as the costs associated with additional medical assistants, nurses or administrative staff employees to complete these tasks.
This magnitude of uncompensated time often leads to physician burnout and forces many physicians to close their practices, says Valenti. Eighty percent of physicians reported being overextended or at capacity, according to the Physicians Foundation 2016 Biennial Physicians Survey. Forty-nine percent said they often or always feel burnt out.
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In addition, only 33% of physicians now identify as independent practice owners or partners, down from 48.5% in 2012, according to the 2016 survey.
“So many independent practices are folding because they can’t keep their heads above water … I know doctors who are simply paying their staff, and they’re not even collecting a salary anymore just out of respect for the people who have stuck with them over the years,” he says.
Valenti suspects primary care physicians probably spend more time on uncompensated tasks than other specialists because they’re the ones who usually perform care management and coordination with other providers. They must also contact insurance companies to obtain prior authorizations.
“I really feel for them. It’s exceedingly difficult for them to do what they do every day,” Valenti adds.