Article

14 minute read 04 October 2022

Giving physicians more time for patient care

Technology and other tools can simplify physician workflows. Explore physicians’ views on where to focus.

Giving physicians more time for patient care

by

Shaun Rangappa, MD
Kumar Chebrolu
Chris Shudes
Natasha Elsner
Madhushree Wagh

Physicians’ job satisfaction and personal well-being are at an all-time low. The culprit? Time constraints and administrative demands that prevent them from spending quality time with patients.¹ While technology isn’t always the answer, it can play a meaningful role in simplifying physician work—if it’s developed with humans in mind, represents a thorough understanding of user needs and preferences, and prompts an honest discussion of pros and cons.² Physicians are also open to delegating or shifting their work to nontraditional settings to streamline their work processes.

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In the Deloitte 2022 Survey of US Physicians, conducted between January and March 2022, 660 physicians shared their views of market trends that impact the current and future state of practicing medicine. The survey found that automation of administrative tasks like billing and documentation has nearly doubled since 2020, but that direct patient care activities like communicating test results and answering patient questions continue to be less conducive to automation.³ To build on the progress already made, our survey revealed additional opportunities to improve physician workflow:

Physicians say prior authorizations (72%), communications with pharmacists (71%), and provider credentialing (64%) are the biggest opportunities.
Given a choice, most physicians favor technology-enabled solutions (even if they aren’t perfect) over today’s common practices.

As health care systems ride out the pandemic, they should thoughtfully consider ways to transform workflows, so physicians have more time and cognitive capacity to focus on what’s most important: the patient.

Automation of nonclinical activities shows progress

Our survey results show automation is on the rise, with physicians in outpatient settings, particularly primary care physicians (PCPs), reporting the largest gains. Overall, automation has increased across eight out of nine activities trended against 2020. In particular, automation of coding activities required for billing and clinical documentation nearly doubled from 15% in 2020 to 27% in 2022. About one-quarter of physicians say activities related to medications and charting have been automated (figure 1).

In contrast to administrative activities, direct patient care activities are the least likely to already be automated and are less conducive to automation, according to physicians. In fact, two in five physicians say it’s impossible to automate the communication of care-related information to patients (42%) and patient visits for routine care or wellness(36%). Nonetheless, our data shows early signs of progress in automating direct patient care tasks:

Sixteen percent of physicians in 2022 (up from 8% in 2020) say their practices have automated patient visits for routine care or wellness
Twelve percent (vs. 8% in 2020) say they use automation to answer patient questions, communicate test results, and relay discharge instructions.
PCPs report the highest adoption, with 24% using automation for routine care or wellness visits and 17% for answering questions and communicating information.

We observe a strong relationship between the use of automation for communicating with patients and the adoption of virtual health technologies that support patient-generated data. One in four physicians has implemented at least one of the following virtual health modalities: remote patient monitoring at home, data from wearables that is incorporated into electronic health records (EHRs), patient-reported outcomes through a digital application, or chatbots or virtual assistants that answer common patient questions.⁴ This group is a lot less skeptical about using automation for answering patient questions and communicating information (27% say it is impossible) than those without such technology (47%). However, we do not see the same pattern when it comes to automating patient visits, at least not yet.

As physicians see benefits from using technology in areas that are adjacent to or touch upon direct patient care, we expect them to become more open to giving technology a try for direct patient care work. We acknowledge, though, that just because something is possible to do doesn’t mean it should be done, and technology may not always be the right tool. Understanding what physicians and patients want should be part of the thinking. For instance, research shows that direct patient care is often the most enjoyable part of physicians’ work, suggesting that the goal here should be to improve rather than eliminate this aspect of physician work.⁵

Despite progress, many opportunities for technological solutions remain

More than 70% of physicians identify prior authorizations (PAs) and communications with pharmacists as the biggest workflow issues to be solved with technological solutions (figure 2). These findings are not surprising given physicians’ long-held frustration with the PA process. Despite policy and technology efforts to reduce PAs, their volume has not decreased over the years.⁶

The frustration over opacity and variability of PA requirements has been exacerbated by health care staff shortages. In an environment of resource constraints, there may not be dedicated staff to deal with PAs. As a result, PA requirements compete with direct patient care, yet without completing these requirements, clinicians are unable to give patients the care they need; and this adds to their frustration and burnout. In a recent advisory on the state of healthcare workers, the Office of the Surgeon General specifically calls out PA as an example of administrative burden that health systems and payers should address to improve health care worker well-being.⁷

While a number of nonclinical tasks easily lend themselves to automation, activities related to care processes are less likely to be helped by technology, in physicians’ views:

Patients’ adherence to treatment, preoperative, discharge, or other instructions: 23% of physicians say it is impossible to solve this with technology.
Care gap closure: 21% say it is impossible to solve with technology and 13% say it is not a challenge for their practice.⁸
Preoperative care planning: 12% say is impossible to solve with technology and 18% say it is not a challenge.

Physicians’ reactions vary by care setting, employment, and generation

Physicians’ perception of challenges in the existing workflow are not uniform in our survey findings, pointing to different needs depending on primary work setting (outpatient vs. inpatient), practice setting (independent vs. employed), specialty, and other characteristics. A few examples:

PA-related activities are less likely to be viewed as challenges in inpatient than in outpatient settings.
With credentialing, independents are more likely than employed to say it’s a solved issue.
When it comes to patient adherence to treatment and care instructions, employed physicians are much more skeptical than independents about solving this with technology.
Care gap closure is not a challenge for one in five independent physicians.
Preoperative care planning and patient education are not a challenge for 28% of nonsurgical specialists.

Additionally, our survey results reveal large differences by years in practice in what physicians see as challenges. Physicians who have practiced the longest are much more likely to say they either have a solution in place (between 6% and 23%) or the issue is not a challenge (between 10% and 22%). There is a possibility that these physicians have adequate nontechnological solutions or workarounds in place.

Our view is that physicians’ opinions on whether it is a bad idea to solve an issue with technology are more instructive than whether they think the issue is impossible to solve. The overall share of physicians who say it is not a good idea is small (2–10%), suggesting there should be little resistance. That said, technology that’s implemented thoughtfully can help ensure adoption. It entails providing a clear vision of how technology is expected to help, supporting this vision with evidence (e.g., effects on productivity, capacity, care quality, and user experience), and acknowledging potential drawbacks (see sidebar, “Most physicians prefer technology-enabled solutions to today’s common practices” for more information).

Most physicians prefer technology-enabled solutions to today’s common practices

To gauge their interest in solving real-life challenges with technology, surveyed physicians were presented with four scenarios: incorporating drivers of health into decision-making, hospital discharge planning, prescribing medications, and ER utilization. In each scenario, respondents were asked to choose between a conventional approach and a technology-enabled alternative. The conventional approach described how things are commonly done today and outlined the corresponding compromises. The technology-enabled alternative described how today’s process could be improved, but the improvement comes with new shortcomings or tradeoffs (see appendix 1).

In three of the four scenarios, more physicians favor a technology-enabled solution over today’s common practice.

Incorporating drivers of health: Seventy-four percent of physicians chose a technological approach for incorporating drivers of health into care plans, even if some of these drivers are estimates derived from secondary data.
Hospital discharge planning: Sixty-five percent of physicians prefer an algorithmic approach to discharge planning that predicts which patients are more likely to develop hospital-acquired conditions even if these predictions are sometimes incorrect, either false positive or false negative.
- Independents practicing in outpatient settings express the most interest in the technology alternative to discharge planning (69%), whereas independents in inpatient setting are the least interested (56%).
Prescribing medications: Sixty percent of physicians favor a solution that compares what is prescribed at the point of care to what should be prescribed, and these prescribing recommendations are based on data reflecting prior prescribing habits.
- Employed physicians in inpatient settings (69%) favor this the most. We interpret that for them such a system wouldn’t represent a major change. Nine in ten of these physicians (91%) already have clinical protocols embedded in EHR and are used to following them: among those with access to clinical protocols, 60% say they follow them all the time and 37% say some of the time.
ER utilization: Physicians are on the fence about patient self-referral to the ER (52%) versus technology-supported triage (48%) that would optimize the site of care by helping patients decide where to seek care. Perhaps, physicians find the risks that may arise from such triage—to cherry-pick or steer patients—outweigh the benefits.

Independents in inpatient setting (62%) are the most likely to favor the conventional approach. We surmise their business model is vulnerable to the risks we outlined, whether it’s from new competition (retail clinics, virtual-only providers) or from unfavorable network status with insurers.

Physicians see possibilities for streamlining their work with automation, delegation, and performing work in a nontraditional setting

Although technology can play an important role, delegation and shifting work into nontraditional settings can help to streamline and simplify physician work. We asked physicians to separately estimate the proportion of their work that can be automated, delegated, or performed in settings other than traditional health care facilities. In the last two years, the amount of work physicians say is possible to automate (18% in 2020 vs. 20% in 2022), delegate (30% vs. 21%), or perform in nontraditional settings (29% vs. 26%) has decreased or saw little change (figure 3).

The severe shortage of health care workers alongside greater use of contract labor during the pandemic may be responsible for the 9 percentage point reduction (from 2020 to 2022) in the amount of work physicians say is possible to delegate. As experienced clinicians left the profession or switched to contract assignments, many organizations faced a loss of institutional knowledge and experience. As a result, it’s harder for the clinicians who stayed to confidently delegate and, in some instances, find somebody to delegate to.⁹

When we look at the responses by care setting and employment, there is little difference in the amount of work physicians estimate can be performed in nontraditional settings. Also, independent and employed physicians in outpatient settings have a similar notion of how much of their work can be automated or delegated (about 20%). However, independent physicians practicing in inpatient settings say a smaller share of their work can be automated or delegated (about 13%) than their employed counterparts (25%).

Physicians say a smaller share of clinical care (than share of total work) can be automated, delegated, or performed in nontraditional settings (figure 3). Nonsurgical specialists say a higher proportion of clinical care (29%) can be performed elsewhere than primary care physicians (23%) and surgical specialists (18%).

Analysis of responses based on the use of comprehensive care teams points to interesting possibilities.¹⁰ Physicians who routinely use comprehensive care teams estimate that a bigger share of the clinical care they personally provide can be automated, delegated, or shifted to nontraditional sites, whereas this isn’t consistently the case for total work. Perhaps, access to a team of experts spanning multiple disciplines gives them the confidence that clinical work can be done well even if they are not the ones doing it. Our data on the use of care teams also shows that when comprehensive care teams are used, physicians say the teams are highly effective and team members largely operate at the top of their license.

Building solutions that take the burden off physicians

Opportunities abound to alleviate the physician burden through a combination of technology, delegation, shifting work to nontraditional settings, and other tools. While some physicians express skepticism about the ability of technology to solve problems, others are optimistic. We believe this is especially true if there is an honest discussion about what technology can and cannot accomplish and what new issues or unintended consequences may arise.

To make meaningful improvements to physician workflow, health systems and solution developers should have a nuanced and precise understanding of physicians’ needs and build solutions that not only are useful and easy to use but also restore joy in the practice of medicine.

Optimize prior authorizations, especially in outpatient clinics. If PA functionality already exists inside the EHR and is sufficiently robust, health systems should ensure it is turned on and the connections to Surescripts and other prescription adjudication and payer platforms are enabled and accurate. Efforts should be put in place to optimize this functionality for the practice workflow and train the staff on how to use it effectively.
Learn the specific pain points physicians who work in your organization or network face. What’s challenging for some physicians might not be an issue for others. These differences are informed by specialty, practice setting, existing workflows, and even years in practice. Organizations should make sure they understand these dynamics among their own clinical staff and their network providers.
- Conduct needs assessment and identify process improvement opportunities using EHR analytics, ethnographic observations, time use studies, and traditional market research techniques.
- Perform an audit of discreet tasks performed by clinicians and staff. Work with stakeholders to assess the clinical, quality, business, and compliance needs for each existing activity, and look for opportunities to eliminate or combine activities or extract from other sources the data they aim to generate.
- Understand how discrete tasks and processes are connected, where one process ends and the other begins. Often, automating or streamlining a portion of a process doesn’t create savings or efficiencies until the entire process is changed.
- Conduct user experience research early in the development process when there is still flexibility to make changes based on user input. Perform ongoing usability testing as new features are added and processes evolve.
Implement change management to support individuals, teams, and departments in adopting and adapting to the new processes.¹¹ The transition to new processes should be transparent, explainable, and respectful of staff’s time.
Establish operational and governance processes. Specifically:
- Adopt a standard and transparent approach to evaluating and prioritizing use cases for investments. Metrics around value and implementation complexity can be a starting point. For more information, see “Value and complexity can be used to prioritize use cases for workflow redesign.”
- Build a governance structure to bring the discipline and consistent methodology to opportunity identification, evaluation, execution, and KPI measurement.
- Establish a center of excellence that performs the governance oversight and acts as a shared resource to convene experts in technology and process improvement, evaluate opportunities, and drive the implementation.

By instituting the right combination of technology and other solutions, health care organizations can help simplify the physician workflow—and reap the benefits. The goal is to reduce the cognitive burden on physicians, give them more time to spend with patients, and help ensure that clinical value isn’t sacrificed.

Appendix 1. Scenario exercise from the survey

The respondents were presented with a conventional approach and a technology-enabled alternative that came with new tradeoffs. Respondents indicated their preferred approach for each of the four scenarios.

Appendix 2. Value and complexity can be used to prioritize use cases for workflow redesign

Appendix 3. Study methodology

Since 2011, the Deloitte Center for Health Solutions has surveyed a nationally representative sample of US physicians on their attitudes and perceptions about the current market trends impacting medicine and the future state of the practice of medicine.

The biennial survey was fielded from January 18 to March 20, 2022. This survey of 660 physicians is nationally representative of US primary care and specialty physicians with respect to years in practice, gender, geography, practice type, and specialty.

The general aim of the survey is to understand physician adoption and perception of key market trends of interest to the health care and life sciences sectors. In 2022, 660 US primary care and specialty physicians were asked about a range of topics, including virtual health, digital technologies, care teams, health equity, and value-based care.

Sampling approach

We selected a random sample of physician records with complete mailing information from the American Medical Association (AMA) Physician Masterfile, and stratified it by physician specialty, to invite participation in an online 20-minute survey.

The resulting study sample is representative of the AMA Physician Masterfile with respect to years in practice, gender, geography, practice type, and specialty to reflect the national distribution of US physicians.

About the AMA Physician Masterfile

The AMA is the major association for US physicians and its Physician Masterfile contains records of more than 1.4 million US physicians (including AMA members and non-members) and is based upon graduating medical school and specialty certification records. It is used for both state and federal credentialing as well as for licensure purposes. This database is widely regarded as the gold standard for health policy work among primary care physicians and specialists, and is the source used by the federal government and academic researchers for survey studies among physicians.

Tanya Albert Henry, “Medicine’s great resignation? 1 in 5 doctors plan exit in 2 years,” American Medical Association (AMA), January 18, 2022; Bruce Y. Lee, ”Doctors wasting over two-thirds of their time doing paperwork,” Forbes, accessed September 7, 2016.
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Octavio Egea, “Why health care innovation needs human-centered principles,” HIT Consultant, August 17, 2021.
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We have not found agreed-upon definitions in the literature of clinical and nonclinical activities in physicians’ work. We are using the model developed by Eric Apaydin that categorizes physicians’ work into three domains: patient care, administrative work, and office work. Apaydin describes patient care as activities most directly related to the practice of medicine, such as diagnosis and treatment; patient administration work (that we refer to as nonclinical activities) combines clinical and administrative aspects like scheduling appointments and handling insurance issues; and, office work includes purely administrative work like reordering supplies or troubleshooting EHR issues. We do not include examples of office work in our survey. See: Eric Apaydin, “Administrative work and job role beliefs in primary care physicians: An analysis of semi-structured interviews,” SAGE journals, January 9, 2020.
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Bill Fera et. al, Tapping virtual health’s full potential, Deloitte Insights, September 8, 2022.View in Article
Paul Rothman, “Keeping the joy in medicine,” John Hopkins Medicine, accessed September 14, 2022; Paul Hseih, “Why patients should consider direct primary care (DPC),” Forbes, October 28, 2021; Zubin Damania, “Finding joy in physical exam skills,” Stanford Medicine, accessed September 14, 2022.
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AMA et al., “Consensus statement on improving the prior authorization process,” accessed September 14, 2022; Congress.gov, “H.R. 3173 - Improving seniors’ timely access to Care Act of 2021,” accessed September 16, 2022, Congress.gov, “S.3018 - Improving seniors’ timely access to Care Act of 2021,” accessed September 16, 2022; AMA, “Measuring progress in improving prior authorization,” accessed September 14, 2022; Claire Ernst, “Virtually all medical groups say payer prior authorization requirements aren’t improving,” Medical Group Management Association, March 2, 2022; Joyce Frieden, “Prior authorization back in the spotlight on Capitol Hill,” MedPage Today, June 2022.
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U.S. Department of Health and Human Services, Addressing health worker burnout, 2022.View in Article
Care gap refers to the discrepancy between the actual care provided to patients compared to evidence-based best practices in health care.View in Article
Tina Reed, “Health workforce shortages begin to weigh on patient safety,” Axios, March 28, 2022.View in Article
The classic definition of a care team is “two or more health care professionals who work collaboratively with patients and their caregivers to accomplish shared goals.” For more, see: Pamela Mitchell et al., Core principles & values of effective team-based health care, Institute of Medicine of the National Academies, October 2012.
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Deloitte, “Strategic Change Management Services,” accessed September 14, 2022.View in Article

Project team: Wendy Gerhardt led survey development and hypothesis generation. Hemnabh Varia oversaw the fielding, helped with the analysis plan and data interpretation. Our Executive Sponsors Ken Abrams, MD; Bill Fera, MD; and Jay Bhatt, DO, provided guidance and reviews of multiple drafts.

The authors would also like to thank Howard Drenth, Curtis Miller, Mark Snyder, Anubha Bang, Kylie Cherco, Steven Milenkovic, Susanne Roberts, Christine Chang, Rebecca Knutsen, Prodyut Ranjan Borah, Laura DeSimio, Zion Bereket, Gargi Khandelwal, Peggah Khorrami, and the many others who contributed to the success of this project.

Cover image by: Natalie Pfaff.

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