Letter
Open Access

The Burden of Physicians’ Administrative Workload Affects Clinical and Scientific Mentoring

Anna Nia[1][a], Dmitry Zavlin[2][b]

Institution: 1. University of Texas Medical Branch, 2. Drexel University College of Medicine
Corresponding Author: Ms Anna Nia ([email protected])
Categories: Education Management and Leadership, Students/Trainees, Teachers/Trainers (including Faculty Development), Undergraduate/Graduate
Published Date: 01/04/2019
Keywords: administration; electronic health record; billing; faculty; students; residents; teaching

Letter

Dear Sir,

Trust has always been considered as a fundamental attribute of medical profession that gives physicians the foundation to build their professional relationships on. Trust has also been critical in a patient's compliance to treatment and adherence to follow-up appointments. In the same vein, young students on clinical rotations or medical graduates who begin their residency have to trust their physician mentors with their graduate and postgraduate training. Unfortunately, most trainees have heard from their faculty members that the increasing administrative burdens associated with their clinical and academic roles are often exhaustive and redundant (Woolhandler and Himmelstein, 2014). A vast majority of institutions is operated by staff without medical education (Jauhar, 2017). These trends typically originate from stricter insurance regulations on spending and complex compensation algorithms that require immense billing-related activities in our US multi-payer healthcare system (Jiwani et al., 2014). In addition, many physicians are part of different academic committees and have duties to maintain and acquire funding for scientific research.

This non-medical workload ultimately jeopardizes mentors' ability to teach their trainees, and cultivate an intellectual environment to discuss the current literature and stay up-to-date with cutting edge medical technology. These increasing demands on faculty members are also one of many reasons for stagnating physician- and surgeon-scientists (Schafer, 2010; Kibbe and Velazquez, 2017). Face-to-face time between mentees and mentors is still one of the most important requirements to develop a close relationship that would foster an intellectually stimulating environment resulting in mutual trust and consequently a quality education or scientific advancement (Straus et al., 2013). A lack of availability may diminish the trust in a mentoring relationship and lead to poor mentee progress.

Simplification and optimization processes in the economic and regulatory structures of US healthcare are necessary to open time and resources of faculty physicians and strengthen both the clinical education and the scientific advancement of young trainees. Automatization of recurring duties, delegation of basic tasks to non-doctoral staff, and the use of human assistance technology (i.e. dictation devices) are further measures that can be taken by attending physicians (Rao et al., 2017) as well as residents (Podnos et al., 2003).

Take Home Messages

  • Administrative workload increasing for faculty physicians
  • Reasons are predominantly of economic healthcare nature
  • Residents as well as M.D. or Ph.D. students suffer from limited mentor availability
  • This burdens the creativity and productivity of our younger generation
  • Measure for protective faculty mentorship time need to be implemented

Notes On Contributors

Ms. Anna M. Nia graduated from UCLA with a B.S. in Neuroscience (2012) and a M.S. in Bioengineering (2015). She is currently a M.D.-Ph.D. student at the University of Texas Medical Branch conducting large data analysis using various bioinformatics and machine learning tools collected from different experimental conditions. Ms. Nia developed and drafted the manuscript.

https://orcid.org/0000-0003-2757-7267

 

Dr. Dmitry Zavlin graduated with distinction from the medical school of the Technical University of Munich (2015) and subsequently finished a 2-year postdoctoral fellowship at the Houston Methodist Hospital where he published numerous peer reviews articles. He currently works as a resident physician at a general surgery program in Easton, Pennsylvania. Dr. Zavlin reviewed and revised the manuscript.

https://orcid.org/0000-0003-3753-5511

Acknowledgements

None.

Bibliography/References

Jauhar, S. (2017) 'Shouldn’t Doctors Control Hospital Care?', The New York Times, 10/11/2017, p. A23.

Jiwani, A., Himmelstein, D., Woolhandler, S. and Kahn, J. G. (2014) 'Billing and insurance-related administrative costs in United States' health care: synthesis of micro-costing evidence', BMC Health Serv Res, 14, p. 556. https://doi.org/10.1186/s12913-014-0556-7

Kibbe, M. R. and Velazquez, O. C. (2017) 'The Extinction of the Surgeon Scientist', Ann Surg, 265(6), pp. 1060-1061. https://doi.org/10.1097/sla.0000000000002192

Podnos, Y. D., Williams, R. A., Jimenez, J. C., Stemmer, E. A., et al. (2003) 'Reducing the noneducational and nonclinical workload of the surgical resident; defining the role of the health technician', Curr Surg, 60(5), pp. 529-32. https://doi.org/10.1016/s0149-7944(03)00004-7

Rao, S. K., Kimball, A. B., Lehrhoff, S. R., Hidrue, M. K., et al. (2017) 'The Impact of Administrative Burden on Academic Physicians: Results of a Hospital-Wide Physician Survey', Acad Med, 92(2), pp. 237-243. https://doi.org/10.1097/acm.0000000000001461

Schafer, A. I. (2010) 'The vanishing physician-scientist?', Transl Res, 155(1), pp. 1-2. https://doi.org/10.1016/j.trsl.2009.09.006

Straus, S. E., Johnson, M. O., Marquez, C. and Feldman, M. D. (2013) 'Characteristics of Successful and Failed Mentoring Relationships: A Qualitative Study Across Two Academic Health Centers', Acad Med, 88(1), pp. 82-89. https://doi.org/10.1097/ACM.0b013e31827647a0

Woolhandler, S. and Himmelstein, D. U. (2014) 'Administrative work consumes one-sixth of U.S. physicians' working hours and lowers their career satisfaction', Int J Health Serv, 44(4), pp. 635-42. https://doi.org/10.2190/HS.44.4.a

Appendices

None.

Declarations

There are no conflicts of interest.
This has been published under Creative Commons "CC BY-SA 4.0" (https://creativecommons.org/licenses/by-sa/4.0/)

Ethics Statement

This manuscript is a letter to the editor. No ethics approval needed.

External Funding

This paper has not had any External Funding

Reviews

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Mohamed Al-Eraky - (26/04/2019) Panel Member Icon
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Thank you for this interpreting perspective. I 'partially agree' with the authors that face-to-face meetings are important in mentoring relationships. Yet, it’s not about the durations and frequency of these meetings, but the quality of mentoring. Mentoring is a skill that can be taught and assessed. That’s why we need to acknowledge mentoring as a standalone role, among others, played by physicians or faculty members, such as: patient care, teaching duties and administrative work.

One solution can be offering options for practitioners to excel in one or two of the above roles, not all of them. This will create different pathways for their professional development, depending on their interest and abilities.

Kind regards,
Mohamed Al-Eraky
Trevor Gibbs - (16/04/2019) Panel Member Icon
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I cannot imagine that any faculty member reading this letter would not sympathise and agree with the author. I would fully support my co-reviewer in suggesting that we need more research into this area before we are past the point of no return
Gert Van Zyl - (09/04/2019) Panel Member Icon
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What a well written letter that addresses two very important issues: administrative workload and academic mentorship. It goes without saying the impact of these wo issues on the academic environment. We all spend time on the first area of administration with significant impact on academic mentorship and other areas of research. An academic leadership challenge to be addressed! Please take your letter to the next level and do some reserach on the impact and provide some solutions to the problem. It will be a winner!
Sateesh Babu Arja - (05/04/2019) Panel Member Icon
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Very simple and well-written letter. It is very interesting to see this letter from an MD-Ph.D student. Mentee and mentor relationship is very important to provide feedback regarding assessments and research work. This feedback is essential to improve learning. This feedback should be provided in a timely manner and be specific to be effective. This requires a lot of faculty's time and faculty development activities. I can understand the concern of the author of non-availability of time to the faculty due to physicians' administrative workload. This is a problem yet to find a solution.
Johannes Hempe - (03/04/2019)
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I read the article with interest and concur with many of the statements. From personal experience, I have seen many faculty spend much of their time on paperwork - time that could be used otherwise.