Adaptation, prevention urged to address administrative burden

We appreciate the article “Administrative burden in primary care. Critical review” by Storseth et al, published in the June 2025 special research issue of Canadian Family Physician.¹ The review offers an important summary of how administrative tasks are overwhelming clinicians, particularly in primary care. It rightly highlights how the volume of often uncoordinated demands—electronic medical record requirements, referral processes, mandatory forms, etc—is contributing to physician burnout and attrition and ultimately reducing access to care for patients. The authors propose several interventions, such as better remuneration, the use of scribes, and streamlining documentation. While these suggestions have merit, they tend to be more reactive, addressing burdens once they become entrenched, rather than preventive.

In contrast, the Doctors of BC policy paper, “Creating space for doctors to be doctors: A cumulative impact lens on physician demands”² takes a wider approach. Rather than prescribing fixed solutions to specific burdens, it introduces a cumulative impact lens: a framework to assess the implications of any new initiative or requirement before it is introduced. This represents a shift in mindset to proactive evaluation of the impact of emerging or changing requests, and ensures the burdens are not, in most cases, downloaded onto other members of the care team. We heard from stakeholders like nurses and allied health professionals that task shifting was not a viable solution in most instances due to the surplus of demands already faced by other health professionals.

The Burdens Solutions Tool (https://www.doctorsofbc.ca/sites/default/files/addressing_physician_burdens.pdf) and accompanying principles outlined in the Doctors of BC policy paper emphasize a collaborative, iterative process that embeds physician engagement and system-wide thinking. The focus is not just on solving isolated problems but also cultivating institutional readiness to avoid future burden accumulation. This framework encourages policy-makers and system leaders to ask key questions about cumulative load, workflow integration, and sustainability before implementing changes. With physician partners engaged, they must explore questions such as the following: Is the ask necessary or can it be eliminated? If necessary, can it be made any simpler? Could the task be better managed when shared with clinical and administrative supports? If it must be done, is it as simple as possible and collaboration optimized? Is there enough time, remuneration, or other resources to make it feasible? Regardless of the solutions used, are physicians given enough time and information to adjust?

This policy work is now incorporated into the 2022 Physician Master Agreement³ in British Columbia, and has been instrumental in advocating for regulatory changes in the province’s approach to sick notes.⁴ It has also impacted the design of physicians’ administrative tasks in the context of WorkSafeBC and the Insurance Corporation of British Columbia, empowered pilot testing of artificial intelligence–assisted scribes,⁵ and is poised to streamline medical imaging appointments in the province’s most populous region.⁶

Work to assess and reduce the burdens of special authority forms for access to specific medications, standing-order laboratory policies, and processes for accessing BC Cancer are also under way. Solutions will not be piecemeal but transformative, thanks to this new approach.

While Storseth et al provide a valuable articulation of the problem’s scope, which is massive, it is the Doctors of BC’s lens-based approach that offers a dynamic and durable path forward for long-term success. By centring an evaluative process over predetermined solutions, the cumulative impact lens fosters adaptability in a constantly evolving health care environment—a quality that is essential if we are to meaningfully reduce administrative harm and support physicians across Canada to focus on caring for patients.

• Copyright © 2025 the College of Family Physicians of Canada