During office hours, physicians spent 27% of their time providing direct clinical face time to patients, according to data published in the Annals of Internal Medicine.
Physicians also spend almost 50% of their time on electronic health records and desk work during the day in addition to an extra 1 to 2 hours each night during their personal time, Christine A. Sinsky, MD, from the American Medical Association, and colleagues found.
"Ambulatory care in the United States has been subject to dramatic pressures in the past decade to cut costs, meet regulations, and transition to electronic health records (EHRs)," Sinsky and colleagues wrote.
They noted that previous studies have not investigated effects on ambulatory care, but evidence on consequences such as burnout, increased dissatisfaction, poor communication with patients and increased time documenting care has become more prominent.
"Fifty-four percent of U.S. physicians experience some sign of burnout, an increase from 46% in 3 years (P < .001)," the researchers wrote. "Time spent in meaningful interactions with patients and the ability to provide high-quality care are powerful drivers of physician career satisfaction. Conversely, physician dissatisfaction has centered on the changing content of their work, with more time spent on paperwork and the computer and less time available for direct clinical face time with patients. Correlations between increases in EHR task load and physician burnout and attrition have also been shown."
Sinsky and colleagues conducted a quantitative direct observational time and motion study to assess how physicians allocated their time in ambulatory care. They observed 57 physicians for 430 hours in four states who specialized in family medicine, internal medicine, cardiology and orthopedics. Of these physicians, 21 also kept diaries about after-hours work.
Results showed that physicians spent 49.2% of their time on EHR and desk work and 27% on direct clinical face time with patients. In the exam room, physicians spent 37% of their time on EHR and desk work and 52.9% on direct clinical face time.
The researchers reported that 26 physicians used some kind of support — either dictation or a documentation assistant. Physicians without support spend 23.1% of their time on direct clinical face time with patients, compared with physicians who used dictation (31.4%) or a documentation assistant (43.9%).
Physicians who kept diaries reported that they spent 1 to 2 hours each night on after-hours work, mostly consisting of EHR work.
"Our study sheds light on physician time distribution between EHR and desk work and direct clinical face time," Sinsky and colleagues concluded. "For every office hour spent on direct clinical face time with patients, physicians in our sample spent nearly an additional 2 hours on EHR and desk work. Physicians spend nearly half of the total office day on EHR and desk work and less than one third on direct clinical face time with patients. They also spend 1 to 2 hours of personal time at home ach night to ‘keep up.’ We recommend further study to identify links between variations in use of physician resources and clinical, financial, and professional satisfaction outcomes."
In an accompanying editorial, Susan Hingle, MD, from the SIU School of Medicine, wrote that this research confirms that EHRs occupy a large portion of doctors' time and take attention away from both patient and personal time, which is something many physicians have claimed.
She noted that both the AMA and the American College of Physicians have created programs and initiatives aimed at providing physicians with strategies to reduce administrative burdens, but called for more action.
"EHRs were implemented to improve the efficiency and quality of patient care, but they have yet to achieve that promise," Hingle wrote. "Effectively addressing the challenges of modern-day practice requires such data as Sinsky and colleagues' study provides. These data document what physicians have long believed: The work of physicians has changed dramatically in recent years, partially due to EHRs. Additional time and motion studies would enable examination of the effect of strategies, such as scribes or advanced care teams, on practice efficiency, physician burnout, and patient satisfaction. Now is the time to go beyond complaining about EHRs and other practice hassles and to make needed changes to the health care system that will redirect our focus from the computer screen to our patients and help us rediscover the joy of medicine." – by Chelsea Frajerman Pardes
Disclosures: Sinsky serves on the advisory committee for healthfinch, a start-up that works on practice automation. Please see the full studies for a complete list of all other authors' relevant financial disclosures.