Physicians have begun charging patients hundreds of dollars to write sick notes and approve medication refills, industry experts have said.

Administrative tasks that were previously free are being monetized across the country due to growing demands on medics’ time and to put patients off submitting non-urgent requests.

Services range from just a few dollars for responding to messages to over $100 for prescription refills.

‘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. 

Paperwork fees can range from a few dollars to a few hundred dollars

The above data is from an Athenahealth survey conducted late last year on doctors

‘It’s actually much more than just the money. It’s really my time.’

‘I know a lot of people who have not had [a fee] now thinking about putting it in because they’re overwhelmed,’ Dr Pearl told Axios.

Replying to swathes of emails from patients and requests for documents can add hours of unpaid labor onto doctors’ work day.

Kacie Lewis, 29, manages her health concerns online. Since late 2021, she had been billed $32 for each of three email threads, wanting 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 health care organizations, including some of America’s biggest hospital systems such as the Cleveland Clinic, have started charging extra for things like electronic messaging.

As of November 2022, the Cleveland Clinic bills for virtual messaging.

Most private insurance will cover the chargeable messages, it said, but if it is not a covered benefit or patients have a deductible they could owe $33 to $50, according to the system.

Most Medicare patients will not be charged, though some will have a $3 to $8 charge, and those with secondary insurance will owe $0. 

Since the Covid pandemic, doctors – who earn an average of $350,000 per year – say they are more burned out than ever, and the emphasis on virtual care has made more patients adapt to interacting with their doctors online.

More than 90 percent of doctors in America report feeling burnt out on a regular basis, while 60 percent say they have considered leaving the profession entirely, a survey of 1,000 doctors by health company Athenahealth found this week.

Many doctors said excessive paperwork and patient demands were leading to their burn out, and they needed to work an extra 15 hours per week on average just to stay on top of their workload.

Increasing amounts of high-deductible health plans, which require patients to take on more of the cost of their care, means patients are trying to find ways to skirt trips to the doctor and may message them instead, Dr Pearl said.

Patients are not always adept at knowing what they should approach their doctor about and what is not urgent, said A. Jay Holmgren, an assistant professor at the University of California, San Francisco’s Center for Clinical Informatics and Improvement Research.

During the pandemic, patient emails skyrocketed as people could not visit their doctor in-person, which led to more providers charging for responses.

The hope is that fees for sick notes and refills will put people off non-urgent requests while allowing doctors to focus on more timely asks.

Employers may also be partly to blame. Increasing numbers of employers are asking employees for sick notes for taking sick days, said Michael Botta, co-founder of Sesame, a startup primary care provider that patients pay directly rather than using insurance.

In 2023, Sesame charged a $29 service for doctors’ notes, which included a virtual appointment that would culminate in the doctor’s letter if it was needed.

Doctors may take back these fees if their economic outlook gets better or if artificial intelligence shoulders more of the administrative tasks, said Jon Freedman, a digital strategist with health care consulting firm Chartis.

It comes as experts warn of a crisis ‘of huge proportions’ hitting the country’s health service — with too few roles going filled.

There were about 193,000 job openings for nurses in the US over 2023, estimates suggest, and about 60,000 openings for doctors.

Many hospital systems were also rocked by staff strikes in recent months, amid disputes over pay and working conditions.