Your doctor’s administrative burden is a public health crisis

I recently facilitated a panel discussion for a group of about a dozen doctors. It is a task that I have literally performed hundreds (if not thousands) of times over the past 15 years.

We worked our way through the evening’s agenda and the conversation was predictable, yet still engaging and lively.

I asked a question along the lines of ‘what are the major factors you consider when initiating or switching patients to new specialty drugs?’. At the request of our client, I also threw in the caveat that efficacy, safety and tolerability were a given. These factors were not to be considered, since it was fairly obvious that no clinician was going to use a drug that lacked efficacy or that presented safety and tolerability issues for their patients.

While the responses varied from consideration of the patient’s lifestyle to consideration of insurance coverage to consideration of caregiver support, one unifying theme came out loud and clear: all things being equal, the drug that presented the lesser/least amount of paperwork would be the clinician’s preferred choice.

All things being equal, this is not a surprise. “What about when things aren’t exactly equal?” I asked the group. Let’s say one drug might have slightly reduced efficacy at 24 weeks or 52 weeks based on clinical trial data or real-world experience. Let’s say one drug has some transient GI distress as a known side effect for a few weeks compared with another agent that doesn’t.

How do you decide then? The answer was clear: paperwork.

Now, to be precise, this only applies to complex specialty drugs and not high blood pressure pills or oral contraceptives. And, of course, it’s not every specialty drug. And, of course, it’s not every single doctor.

But it’s not a ‘nothing burger’ either.

So, I clarified: if all things are equal or slightly unequal (but not to the extent that it presents a safety concern), the amount of paperwork required to get the patient on a drug, either themselves or with the company’s patient support programme, is a defining issue.

The resounding answer was ‘yes’.

That an ever-increasing administrative burden for physicians has been an issue is not surprising. But it has always been framed in the context of this burden robbing physicians of valuable face time with patients. That the face-to-face interactions, shared decision-making and need for empathy in healthcare are the victims in this never-ending tug-of-war with mammoth reams of paperwork.

It has rarely, if ever, been framed as one of the top reasons that drive the adoption and initiation of therapeutic agents, thereby playing a critical role in patient outcomes.

After that focus group session, I thought that this must be a unique trait specific to this particular groups of specialists or this specific class of drugs. I called and emailed 200 physicians from various specialties and asked them the same question: does the amount of paperwork that you have to do or that you have to review from a patient support programme’s case manager dictate your willingness to prescribe one agent over another (all things being equal or slightly unequal, as defined earlier). Of these, 164 physicians agreed or strongly agreed with the statement. That’s 82%.

Yes, this is an unscientific methodology. Yes, there is undoubtedly some bias in the survey. Yes, there are many, many confounding variables at play.

It’s still an important insight.

Decisions are being made about treatment regimens that are not based on a drug’s clinical profile. This is not a judgement or indictment of medical professionals. It is simply an observation.

I don’t know what the answer is. There is likely not one single answer. Governments may need to allocate increased funding or subsidies to private practice and hospital-based physicians to help. Industry may need to beef up the number of case managers to alleviate and shift some of these workload issues from physicians to their patient support programmes. Insurance adjudicators may have to take on an increased role in performing some of these tasks. Artificial intelligence will, unquestionably, have to play a role.

One problem. Many solutions.

It is a stretch to say that solving this problem will cure healthcare of all that ails it. However, it is not a stretch to suggest that this is a burgeoning crisis. It is not a stretch to suggest that any mechanism that gives clinicians more time away from their computer screens will benefit patients. And it is not a stretch to suggest that a multi-pronged solution needs to be undertaken sooner rather than later.