German Doctors Spend Three Quarters of Each Day on Paperwork

A recent survey by the Marburger Bund North Rhine-Westphalia/Rhineland-Palatinate region in Germany revealed serious problems. Senior physicians in German hospitals only have about 2.5 hours per day for direct patient care. More than 5 hours per day are spent on administrative activities.

Participants included 1475 senior physicians, 464 senior physicians, 81 chief physicians or chief physician representatives, and 115 physicians who hope to serve as senior physicians.

Excessive bureaucracy not only leads to less time spent treating patients but also leads to significant deficits in the training of residents, according to the survey. Nearly 60% respondents said they rarely or never have enough time to train residents.

Personal development also suffers. About 75% senior physicians surveyed lack resources for continuing education during working hours. About 43% of them do not receive any financial support from the employer for this education.

The shortage of physicians is also noticeable, as the survey results showed. About 28% senior physicians report vacancies in their department. On average, there are 1.3 positions per department. About 49% senior physicians report vacancies among physicians in training, with an average of 2.3 open positions.

These staff shortages result in an additional burden on the remaining employees because the work must be performed by fewer clinicians.

Another problem is the recording of working hours. About 26% senior physicians reported that their time is recorded electronically and automatically. For 47%, the recording takes place electronically, but with manual entry, and for 26%, working hours are still recorded completely manually. This practice often does not comply with the provisions of the collective bargaining agreements.

The survey results are not surprising. As early as July 2024, the German Hospital Institute warned about excessive bureaucracy.

A flash survey showed that physicians at all levels and nurses spend an average of one third of their working time on documentation and proof requirements, which amounts to almost 3 hours per day. Statistically speaking, about 34% nurses and 36% physicians are exclusively occupied with bureaucracy and are not available for direct patient care.

The requirements of the medical service and internal or external quality assurance are particularly time-consuming. Here too, the authors concluded that less bureaucracy would significantly increase the time for patient-centric activities and reduce the shortage of skilled workers.

A total of 98 psychiatric hospitals and 225 general hospitals with 50 or more beds took part in the representative survey.

Bureaucracy in medical care was a recurring theme in Medscape’s report on burnout and depression and its report on job satisfaction.

About 46% physicians surveyed spend 15 or more hours on administrative activities — more often in the clinic than in the practice. Doctors also reported “too much administration and documentation” as the most important risk factor for depression or burnout.

So what needs to change? At the 128th German Medical Congress in 2024, delegates called for measures to reduce bureaucracy to put the focus back on patient care. Policymakers once again advocated a law to reduce bureaucracy. “Rapid democratization is the basic requirement to maintain patient care as talent and a society of long-life grows,” it said in an application.

This story was translated from the Medscape German edition using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.