We are taught to fix the system – then forced to waste time in it

As medical students in Canada, we’re immersed in conversations about efficiency, burnout and health-system strain. In our lectures, we analyze case studies on the primary care crisis. In clinics, we see overworked family doctors struggling to squeeze in one more patient. We are taught to be stewards of the system through judicious antibiotic use and appropriate referrals. Yet, we’re routinely forced to participate in the exact causes that exacerbate it: unnecessary paperwork and testing.

Every year, medical students across the country must submit forms verifying their vaccine history – forms that we already submitted last year, and the year before that. In reviewing yearly immunization forms from schools nationwide, it is clear that these forms often are nearly identical, and the information requested, such as documentation of the original COVID-19 vaccines and a yearly tuberculin skin test (TST), rarely changes. Yet, each year we are asked to get them refilled, re-signed by a physician or nurse and re-uploaded into institutional portals. These redundancies are particularly concerning when they directly contradict current public health recommendations.

The Centre for Disease Control and Prevention and the Canadian Tuberculosis Standards recommend screening for tuberculosis (TB) upon hire and recommend against yearly tuberculin skin testing unless there is a known exposure or ongoing transmission at the particular facility. Furthermore, although the Council of Ontario Faculties of Medicine (COFM) states that “annual TST screening for TB is not necessary in most settings,” many Ontario medical schools still require yearly TSTs while paradoxically citing the same COFM document in their immunization policies.

The false positive rate of the TST is an additional concern – the test has a specificity of 97 per cent in the general population and 59 per cent among those who have received the Bacillus Calmette–Guérin vaccine. Considering there are more than 11,000 medical students in Canada who are tested yearly, a specificity of 97 per cent may lead to a significant number of false positives and subsequent exposure to radiation. Moreover, students who have previously tested positive for TB, regardless of whether they have a true infection, must sign an acknowledgement that they have not developed symptoms of TB and attach a chest X-ray. While it is an additional burden to re-attach the same chest X-ray year after year, this also begs the question: Why can’t all students acknowledge that they have had no known exposures or symptoms? And why does the same chest X-ray need to be re-sent, year after year?

Some hospitals we rotate through, despite the sites falling under the same provincial immunization requirements and student health systems, also require separate forms to be completed by our primary care practitioners. They can request childhood vaccinations and proof of immunity to illnesses such as Hepatitis B, all of which we had to provide proof of when we enrolled in medical school. We even require a different form if we choose to rotate at universities other than our home one, again, a separate form with the same information.

At best, it’s an inconvenient and redundant exercise. At worst, it’s a wasteful and demoralizing use of student, staff and clinician time.

At best, it’s an inconvenient and redundant exercise. At worst, it’s a wasteful and demoralizing use of student, staff and clinician time – not to mention often paid for out-of-pocket by students. The Ontario Medical Association recommends that providers bill patients $60 at minimum to fill out immunization forms. While many providers choose not to charge their medical student patients this $60 each year, they lose appropriate compensation for the time they spend on this paperwork.

Moreover, it adds to the already overwhelming administrative workload faced by primary care physicians. According to a survey conducted by the Ontario College of Family Physicians in 2023, family doctors reported spending approximately 19 hours per week on administrative work – most of which is unpaid and some of which is unnecessary; 94 per cent of respondents reported being overwhelmed with clerical tasks and that about 40 per cent of their time is spent on administration rather than direct patient care. Similarly, according to the Canadian Medical Association, 18.5 million hours are spent annually by physicians on unnecessary administrative tasks and 75 per cent of physicians say their administrative workload is a barrier to caring for their patients.

It is worth asking what the purpose of these repetitive requirements is. If the goal is safety, surely there are smarter, more centralized ways to verify immunity status without asking students to find time to visit their doctor. If the goal is administrative thoroughness, perhaps the system should reflect the same critical eye we are taught to apply to patient care: don’t order the same test twice without a reason. Don’t waste resources. Don’t burn out your team.

This isn’t merely about vaccine paperwork. It’s about what it signals – a symptom of a system in which bureaucracy overrides basic logic. We need to do better, not only for the mental well-being of our practitioners but to model the kind of health system we’re being asked to lead.

If we are serious about addressing the family medicine crisis, about keeping trainees in Canada and encouraging them into primary care, we should start by respecting their time. Streamline the paperwork. Centralize immunization records. Allow for multi-year verification unless something changes. These are low-hanging fruits in a system starving for efficiency.

We can’t fix the Canadian health-care system by teaching students to live with waste. We need to teach them to challenge it and then actually listen when they do.

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