News

Family physicians have been saying it for years: the administrative load outside the exam room is growing.  

Now there's data to prove it.  

New research from Dalhousie University's Department of Family Medicine found that between 2011 and 2021, per-visit referrals increased by 57 per cent and lab test orders by 29 per cent—quantifying a trend clinicians have long reported but rarely been able to measure. 

The findings are part of A Thousand Papercuts: Understanding and addressing changing administrative workload in primary care, a Dal-led research program that studied administrative burden in primary care across Nova Scotia and New Brunswick. By interviewing physicians, nurse practitioners, and administrative staff, they hoped to determine what's driving the problem and what could help. 

Administrative work contributes to stress and burnout

Participants described administrative work as often centered on information management—ensuring accurate transfer of information between people and systems, such as completing referral forms. Without appropriate support and tools, this work falls disproportionately on family physicians and their teams as an individual burden.  

When family physicians feel a deep responsibility to their patients but face administrative demands within systems they have little power to change, the result is often burnout and moral distress. Participants reported that growing volume and complexity of administrative work are intensifying these pressures, yet until now, there has been little research to quantify that increase. 

How has administrative workload changed? 

Electronic health records have been in use for long enough that they can now be leveraged for research looking at changes over time.  

While there is no comprehensive data capturing time dedicated to other activities, the team used data from more than 900 family physicians across six Canadian provinces and the increase in referrals and lab tests suggests that family physicians are likely spending an increased proportion of their time on administrative tasks relative to direct patient care. This shift may further limit patient access to a family physician. 

“Physicians to whom I presented this work are often quick to reply with ‘I am so glad that this isn’t all in my head,’ so being able to use data from EMRs to confirm their perceptions of increased administrative workload is gratifying,” says Dr François Gallant, lead author of the study.  

What are the potential solutions? 

The research project also included expert conversations with those in clinical, administrative, policy, and service planning roles to identify potential solutions to primary care administrative burden. 

Interviews and expert conversations made clear that there is no single strategy to address administrative workload. Instead, multiple approaches help improve efficiency, including streamlined information exchange, technology tailored to practice, and fair pay and training for administrative staff. 

Work to reduce administrative burden of doctors is already underway in Nova Scotia by removing red tape, updating out of date policies and streamlining processes. But efforts are still needed to make sure all primary care team members have the training and support they need. 

The physicians, nurse practitioners, and staff interviewed are not arguing that paperwork is unnecessary—following patients over time and coordinating care are what make primary care central to an efficient and equitable health system. Instead, they are describing a system that asks them to carry too much, with too little support, inside structures they didn't design, and can't easily change.  

Investing in the conditions that allow family physicians and staff to do their work efficiently and well is essential to a primary care system that meets the needs of patients, and the people who care for them.