Table of Contents
- 0.1 Bureaucratic frustration
- 0.2 Dramatic disparity between bureaucracy and work on patients
- 0.3 Digital infrastructure needs to be improved
- 0.4 Liberation of the medical profession – more time for being a doctor
- 0.5 General facts about training evaluation
- 1 Given the strain on physician time and resources due to excessive bureaucracy, how can hospitals ensure that patient safety and quality of care do not suffer?
Photo: ÖÄK/Karo Pernegger
The 2024 training evaluation by the Austrian Medical Association shows a dramatic disparity: 51.6 percent of working time only for administration. There is one factor that slows down and hinders medical training the most, but also the actual medical work in patient care: the ever-increasing administration and bureaucracy. This was the result of the training evaluation carried out for the second time between March and May 2024 in cooperation with ETH Zurich, in which all doctors in training (that is: all doctors in basic training, training to become a general practitioner and a specialist) were satisfied with the training medical training in Austria were surveyed. Over 4,800 doctors in training took part in the survey.
“In total, 77 percent of those surveyed in Austria stated that they felt their training was restricted by administrative requirements,” summarizes Harald Mayer, Vice President of the Austrian Medical Association and Chairman of the Federal Curia for employed doctors. “We have the same picture when asked whether bureaucracy is also a hindrance when working with patients – 76 percent agree. These are values that ring alarm bells for doctors employed by us in the Federal Curia. For years we have been demanding that documentation assistants be employed in all departments to free our doctors from bureaucratic tasks. However, there is not enough willingness on the part of the hospital authorities to implement this.”
Bureaucratic frustration
It’s not just about writing discharge letters; documentation, administration and bureaucracy now account for more than 50 percent of the working time, especially for doctors in training. “For example, when there are bed closures, our doctors spend hours on night duty just calling around and finding free beds for patients. You don’t actually need a doctor for that.” This also describes the general misery: beds have to be closed due to too few staff, and the remaining staff in turn get entangled in administration – a fatal negative spiral. Mayer: “The frustration of doctors increases more and more – to the point of leaving the health system. We must work together with politicians and providers to ensure that excessive bureaucratic tasks do not cause young people to lose interest in the medical profession. Our doctors want nothing more than to help and support patients – and not to sink into writing.”
Dramatic disparity between bureaucracy and work on patients
Natalja Haninger-Vacariu, the first deputy chairman of the Curia and a rotating doctor representative since April of this year, took office with the specific goal of massively driving forward the reduction in bureaucracy. She finds the figures from the training evaluation on the module question “Administration and Bureaucracy” shocking: “24.5 hours per week are therefore spent on administrative activities or for patient-related medical documentation work on average across Austria, out of the 47.4 hours per week actually worked. This is a dramatic disproportion. For example, only 17.1 hours per week can be used for clinical examinations, visits, operations or discussions with relatives. This is bad for the patients and their care, but also bad for the doctors, who get caught up in nerve-wracking paperwork instead of doing what they actually studied for, namely being there for the patients.”
To provide an even better illustration: In percentage terms, according to the 2024 training evaluation, a total of 51.6 percent of young doctors’ total working time is spent on administrative activities and patient-related documentation, while only 36 percent remains for direct medical care of patients. 12.4 percent are spent on other activities that cannot be attributed to these two areas. “This shows only too clearly that it is high time for medical work to be de-bureaucratized in order to have enough time for high-quality patient care, but also to ensure that our future doctors receive the best training – now and here The figures available do not support the belief that young people in Austria consider the medical profession in its current form to be attractive,” fears Haninger-Vacariu.
Digital infrastructure needs to be improved
Functioning, digital solutions and aids could provide some of the urgently needed relief – however, the training evaluation shows that there is still a lot of room for improvement in local hospitals: across Austria there was only a grade of 4.82 (maximum grade of 6.0). the question of whether there is a reliable, nationwide internet connection that can be used to carry out documentary, medical work efficiently. “In the 21st century you can expect a value that is close to 6.0,” demands Federal Curia Chairman Mayer. “The results for Burgenland and Vienna are really bad at 4.49 – it’s unacceptable that the IT only works mediocre in many places.”
The current situation is even worse when it comes to the question of hardware, i.e. whether up-to-date tablets or computers are available for work: here the training evaluation gives a weak value of 4.17. “The fact that Vienna is at the absolute bottom here with 3.74 should really give the hospitals and their IT something to think about. “That is unworthy of a federal capital,” says Haninger-Vacariu, who is also First Vice President of the Medical Association for Vienna. “We will work to ensure that our doctors, if they are forced to carry out bureaucratic tasks, can at least carry them out with sufficient availability of the latest technical equipment.”
Liberation of the medical profession – more time for being a doctor
“The bureaucratic and documentary activities of our doctors, especially in hospitals, have reached a level that can even endanger our health care,” Mayer summarizes. “Let our doctors finally do what they can and what we have trained them to do for years – namely, be doctors who care for their patients and have enough time for comprehensive discussions, examinations, diagnoses and therapies. I therefore call on politicians to finally support this in practice and to start an initiative to free the medical profession from this excessive bureaucracy!”
General facts about training evaluation
The second edition of the largest and most comprehensive medical training evaluation in the history of the Austrian Medical Association was launched in March 2024. In collaboration between the BKAÄ and the “Consumer Behavior” professorship in the Department of “Health Sciences and Technology” at the Swiss Federal Institute of Technology in Zurich (ETH), questionnaires were developed with a focus on eight different subject areas – from company culture to the transfer of specialist skills on the leadership culture in the training departments. These questionnaires were distributed to the intern doctors by the primary doctors and the medical directors in the hospitals. They had until May to return them anonymously in a prepaid reply envelope – tracing is not possible. The raw data and questionnaires remain at ETH Zurich and will not be published under any circumstances. The Austrian Medical Association only receives aggregated data based on the training institution and not on the basis of individuals. The results are transparent and can be accessed in detail down to the department level under the following link: https://www.aerztekammer.at/ausbildungsevaluierung. The next Austria-wide medical training evaluation will take place in spring 2025 to guarantee continuous quality assurance of medical training.
Source: Austrian Medical Association
Given the strain on physician time and resources due to excessive bureaucracy, how can hospitals ensure that patient safety and quality of care do not suffer?
## Thematic Questions for Discussion Based on the Article:
The article presents a worrisome situation regarding the excessive bureaucracy faced by doctors in Austria, particularly during their training. These open-ended questions are designed to facilitate a rich discussion exploring various aspects of this issue:
**I. The Impact of Bureaucracy on Medical Training and Practice:**
1. The article states that doctors in training spend over 50% of their time on administrative tasks. How does this disproportionate allocation of time affect the quality of medical education and the development of essential clinical skills?
2. How can excessive bureaucracy impact a doctor’s bedside manner, empathy, and ability to build trust with patients?
3. The article mentions a “fatal negative spiral” where bed scarcity leads to increased administrative workload for doctors. Can you elaborate on this spiral and its broader consequences for the healthcare system?
**II. The Role of Hospitals and Healthcare Providers:**
1. What specific steps can hospitals and healthcare providers take to reduce administrative burdens on doctors and improve their working environment?
2. Should hospitals prioritize employing documentation assistants to alleviate administrative tasks from doctors? What potential challenges might arise from this approach?
3. How can hospitals foster a culture that values and supports doctors’ clinical time and patient interaction over administrative tasks?
**III. Technological Solutions and Digital Infrastructure:**
1. The article highlights insufficient digital infrastructure in many Austrian hospitals. How can improved technology and digital solutions contribute to streamlined documentation and administrative processes?
2. What specific types of digital tools and platforms would be most beneficial for doctors in terms of reducing bureaucracy and freeing up time for patient care?
3. Beyond technology, what systemic changes are needed to ensure that digital solutions are effectively integrated into healthcare settings and utilized by doctors?
**IV. The Future of the Medical Profession:**
1. How might the current situation discourage young people from pursuing careers in medicine?
2. What are the long-term implications of excessive bureaucracy on the quality of healthcare, patient outcomes, and the sustainability of the healthcare system?
3. What actions can policymakers, medical associations, and individual doctors take to advocate for reduced bureaucracy and improved working conditions within the medical profession?
**V. Beyond Austria:**
1. Are similar challenges related to bureaucracy and administrative burden experienced by doctors in other countries?
2. Can we learn from successful models or strategies implemented in other nations to address this issue?
3. What role can international cooperation play in finding innovative solutions to improve the working conditions of doctors globally?
Let these questions guide your discussion and encourage participants to share their perspectives, experiences, and potential solutions to this critical issue impacting healthcare.
