What Psychiatrists are spending time on in USA, Canada and UK?
Hello! Thank you for your question about how psychiatrists spend their time in the U.S., Canada and the U.K. Though there is no hard-and-fast resource compiling this data, I was able to use sources like the WHO and Clinical Psychiatry News to triangulate an answer to your question. The short version is that psychiatrists spend the majority of their time with patients and conducting the regulatory paperwork/admin that is required in any medical practice. In fact, data indicates that 49% of a doctor's time is spent on desk work, while only 27% is spent directly with patients. American physicians spend more time on non-patient tasks than both the U.K. and Canada, and in the United Kingdom, doctors spend twice as much time on admin as they do seeing patients.
The variance in patients' needs and diagnoses results in dramatic disparities in time spent on specific tasks from one patient to the next, but the data I recovered provides some powerful insights into how psychiatrists spend their time during a work day and the kinds of time constraints they face in the course of a career.
In my deep dive below, you will find a breakdown of the factors impacting the pace of a psychiatrist's daily schedule. I have also compiled data that will provide some insights into the current state of the industry, in terms of time and schedule, and the overall workload psychiatrists are required to maintain in order to keep up with rising demands.
I began my research by looking for specific data pertaining to the psychiatry industry as a whole. My goal was to find existing, official, precompiled data breaking down the psychiatrist's day and his/her specific working schedule. Unfortunately, this data does not exist in the public forum, so I turned to informal findings. The purported reason for the absence of this data results from the fact that there are too many variables in the treatment process from patient to patient, making it impossible to secure an accurate control group or baseline for data acquisition. However, I was able to triangulate data from a variety of different sources, which allowed me to pinpoint how psychiatrists spend their time during the course of the workday.
WHERE DO PSYCHIATRISTS SPEND THE MOST TIME?
According to one online survey, 42.9% of psychiatrists polled were required to see 14 to 18 patients in an eight hour day. When the administrative requirements per patient are taken into account, it's safe to say that these doctors are only able to spend a few minutes with each patient.
In the same survey, 28.6% of doctors polled said they see between 10 and 14 patients in an eight hour day.
One study said that, in the United States, doctors spend about 16.6% of their time on non-patient related paperwork. Interestingly, a report by the International Journal of Health Services indicated that "physicians in Canada spend far less time on administration than do U.S. doctors, and attribute the difference to Canada’s single-payer system, which has greatly simplified billing and reduced bureaucracy." However, I could not find specific data on how much less time is spent. In the United Kingdom, reports indicate that doctors spend
twice as much time on admin as they do with patients. After an interview about the psychiatry profession and the psychiatry shortage, one American psychiatrist took it upon herself to gather data from her colleagues and notate the time they spend on only the things a doctor of psychiatry is required to do in order to see patients:
-- The maintenance of certification requirements and testing requires a time investment of about 50 hours every ten years.
-- CME (continued medical education) represents a time requirement of 20 to 50 hours each year.
-- Clinical notes are required, but the time spent on these notes varies from doctor to doctor. Some say the time spent on notes is about 30 minutes for every hour spent with the patient, while others claimed clinical notes eat up about two hours in each day. This particular issue evidently increases in high-volume practices.
-- Billing and administrative functions, which take approximately 8 hours pe r month, can sometimes be offset, if the psychiatrist has a secretary or billing staff.
-- Insurance pre-authorizations was also cited as a significant time drain for psychiatrists, though no specific time data was available.
-- Filing insurance claims can also be a time burden, especially for psychiatrists who have no support staff. Here again, no specific time data was available.
-- The biggest complaint about time demands resulted from the requirement to pre-authorize medications. Some psychiatrists claim it takes up to two hours per week just to pre-authorize medications with insurance companies.
-- The paperwork required to maintain credentials with insurance companies takes about 40 minutes every three months.
-- Maintaining credentials and handling the paperwork required by the state or municipality in which a psychiatrists practices is also a time drain. The time requirements for these demands vary from location to location.
-- An electronic medical record (EMR) system was originally established by Medicare and provides financial incentives for doctors who use electronic health records technology. The original belief was that the system would improve patient care, but now the system penalizes doctors who do not have access to the technology. In fact, one psychiatrist reported having worked hundreds of hours on this issue to no avail. Another confirmed having spent three hours in a three-month period attesting to her compliance.
-- E-prescriptions, the electronic submission of prescriptions to pharmacies, can also take up a significant amount of time. If a prescription is non-controlled, the process takes about 4 or 5 minutes per prescription. However, if the doctor seeks to prescribe a controlled substance, the process can take from 7 to 9 minutes per prescription.
-- Psychiatrists also spend time directing secretarial staff and working on office related issues, but there are no available time estimates for these tasks, because each situation and each office environment is different.
-- Psychiatrists also spend time a significant amount of time on uncompensated duties, like returning phone calls and checking up on patients, filling out paperwork for disability claims or conversing with prospective patients who later decide not to come. Many of these things are done on the doctor's own time and after hours. Again, time estimates for this type of work are not available, because each situation is unique and each individual utilizes a different approach.
One psychiatrist took the time to track her duties and discovered that she spends 40 hours per month on administrative issues alone. She also confirmed that those 40 hours had a direct impact on the number of patients she could see during the month.
Another factor impacting the scheduling constraints placed on psychiatrists is the psychiatry shortage. According to the data, the need for psychiatrists is growing in all three of the requested locations and this shortage contributes heavily to the patient case-load for psychiatrists.
Many people complain that they cannot get in to see a psychiatrist, either because of his or her fully booked schedule, or because of insurance restrictions. Others complain that even though they have a psychiatrist, he or she is so pressed for time, there is not enough time for accurate, in-depth treatment.
The research also indicates that one in four individuals in the U.K. will suffer with some form of mental illness or neurological disorder in the course of the year. In both United States and Canada, the number is one in five.
Given the respective populations of each country, and using the aformentioned data, we can deduce that:
-- In the U.K., 16.3 million people will suffer from some form of mental illness annually.
-- In Canada, 7.2 million people will suffer from a form of mental illness annually.
-- In the United States, 64.3 million people will suffer from some form of mental illness annually.
Unfortunately, the number of psychiatrists per capita in each of the respective locations remains low. Data indicates that, in Canada, there are 13.42 psychiatrists for every 100,000 people. In the United Kingdom (including Great Britain and Northern Ireland), there are 14.63 psychiatrists per every 100,000 people. And finally, in the United States, there are 12.4 psychiatrists for every 100,000 people.
When combined with the number of people who will suffer with mental illness annually, from the statistical standpoint, the patient caseload per physician has the potential to be disparagingly high. Though, it's unclear how many individuals suffering with mental illness will see a psychiatrist specifically. Some people are treated for mental illness by their primary care physician and others choose to remain untreated.
To recap, psychiatrists spend the majority of their time with patients, as well as conducting the regulatory paperwork/admin that is required in any medical practice. Data indicates that 49% of a doctor's time is spent on desk work, while only 27% is spent directly with patients. American physicians, of all specialties, spend more time on non-patient tasks than doctors in both the U.K. and Canada, and in the United Kingdom, doctors spend twice as much time on admin as they do seeing patients.
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