Doctors have started charging patients hundreds of dollars to write sick notes and authorize drug refills, industry experts say.
Previously free administrative tasks are being monetized across the country due to increasing demands on doctors’ time and to discourage patients from making non-urgent requests.
Services range from just a few dollars for responding to messages over $100 for prescription refills.
“Basically, doctors are saying, ‘I can’t afford the things I used to do for free,'” says Robert Pearl, a professor at Stanford University and former CEO of The Permanente Medical Group.
Paperwork costs can range from a few dollars to a few hundred dollars
The above data comes from an Athenahealth survey conducted among physicians at the end of last year
‘It’s actually about much more than just the money. It’s really my time.’
“I know a lot of people who haven’t had (payment) yet and are now thinking about putting it in because they’re overwhelmed,” Dr. Pearl shared. Axios.
Responding to large volumes of patient emails and document requests can add hours of unpaid labor to doctors’ workdays.
Kacie Lewis, 29, manages her health problems online. Since late 2021, she has been billed $32 for each of three email threads because she wanted treatments for psoriasis, eczema and a yeast infection from providers at Novant Health in Charlotte, N.C., she told the New York Times.
A growing number of healthcare organizations, including some of America’s largest hospital systems like the Cleveland Clinic, have started charging extra for things like electronic messaging.
Beginning in November 2022, the Cleveland Clinic will bill for virtual messaging.
Most private insurance will cover the paid messages, but if it’s not a covered benefit or if patients have a deductible, they could owe $33 to $50, according to the system.
Most Medicare patients will not be charged, although some will be charged a fee of $3 to $8, and those with secondary insurance will be charged $0.
Since the Covid pandemic, doctors – who earn an average of $350,000 a year – say they are more burned out than ever, and the emphasis on virtual care has seen more patients adapt to interacting with their doctors online.
More than 90 percent of doctors in America say they regularly feel burned out, while 60 percent say they have considered leaving the profession entirely, according to a survey of 1,000 physicians by healthcare company Athenahealth this week.
Many doctors said excessive paperwork and patient demands led to their burnout, and they had to work an average of 15 extra hours per week to keep the workload under control.
The increasing number of high-deductible health plans, which require patients to shoulder a greater share of the cost of their care, means patients are trying to find ways to bypass a visit to the doctor and send them a message instead can direct, said Dr. Pearl.
Patients don’t always know what to see their doctor about and what isn’t urgent, says A. Jay Holmgren, an assistant professor at the Center for Clinical Informatics and Improvement Research at the University of California, San Francisco.
During the pandemic, patient emails skyrocketed as people couldn’t visit their doctors in person, leading more providers to charge for responses.
The hope is that fees for sick notes and refills will deter people from non-urgent requests, while allowing doctors to focus on more timely queries.
Employers may also be partly to blame. More employers are asking employees for sick notes to take sick days, says Michael Botta, co-founder of Sesame, a startup primary care provider that pays patients directly instead of using insurance.
In 2023, Sesame charged a $29 service for doctor’s notes, which included a virtual appointment that would culminate in the doctor’s note if necessary.
Doctors can reclaim these fees if their economic prospects improve or if artificial intelligence takes on more administrative tasks, says Jon Freedman, a digital strategist at healthcare consultancy Chartis.
It comes as experts warn of a crisis ‘of enormous proportions’ hitting the country’s healthcare system – with too few roles being filled.
According to estimates, there were approximately 193,000 vacancies for nurses in the US in 2023, and approximately 60,000 vacancies for physicians.
Many hospital systems have also been rocked by staff strikes in recent months amid disputes over pay and working conditions.