From signing patient documents to emailing responses to patient questions, doctors are increasingly charging fees for administrative tasks.
Fees ranging from a few bucks to a few hundred dollars for paperwork requests risk annoying patients who are used to getting such services for free. But experts say it’s a natural response to growing demands on physicians’ time and shrinking reimbursement.
“Basically physicians are saying, ‘The things that I used to do for free, I can’t afford to do it now,'” said Robert Pearl, a Stanford University professor and former CEO of The Permanente Medical Group. “It’s actually much more than just the money. It’s really my time.”
Responding to a flood of emails from patients and fielding requests for documents can add hours to a doctor’s day for work that would otherwise go unpaid.
“I know a lot of people who haven’t had [a fee] now thinking about putting it in because they’re overwhelmed,” Pearl said.
The pandemic is partly to blame. Doctors are more burned out than ever, and the shift to virtual care has made more patients accustomed to interacting with their doctors online.
That’s generally seen as a good way to improve patient access to care — until it becomes too much.
The growth in high-deductible health plans, which require patients to shoulder more of the cost of their care, also means that patients are looking for ways to avoid visits and so they can message their doctors instead, Pearl said.
Patients aren’t always good at differentiating between what they should be emailing their doctor about and what they can expect, said A. Jay Holmgren, an assistant professor at the University of California, San Francisco’s Center for Clinical Informatics and Improvement Research.
As emails from patients jumped during the pandemic, more health care providers started charging fees for responses.
Holmgren and colleagues in a JAMA study last year found those fees were associated with a slight decline in patient emails.
While patients do email with worthwhile questions, “There’s also a set of things that I sometimes refer to as ‘Call your mother,'” Holmgren said.
The hope is that fees for emails and other medical documentation can help weed out non-urgent requests while ensuring doctors can respond to those with more pressing matters.
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