More than half of physicians practicing in the United States have some sign of burnout, according to recent reports, and previous research has shown a link between increased administrative workload and doctor burnout. Few studies, however, have examined how physician time is allocated in ambulatory care.
For a study published in Annals of Internal Medicine, Christine A. Sinsky, MD, and colleagues sought to describe how physician time is spent in ambulatory practice. The analysis involved 57 physicians in four states, with backgrounds in family medicine, internal medicine, cardiology, and orthopedics. The participants were observed for 430 hours, and 21 of the physicians studied also completed after-hours diaries. The investigators looked at proportions of time spent on four activities—direct clinical face time, electronic health record (EHR) and desk work, administrative tasks, and other tasks—and self-reported after-hours work. “Our goal was to quantify the time that physicians spent on administrative duties,” adds Dr. Sinsky.
The research team found that physicians spent 27% of their day in direct contact with patients and 49% of their time was devoted to using EHRs and other desk work. In the examination room, physicians spent approximately 53% of their time in direct contact with patients and 37% of their time on EHRs and other clerical work. This means that for every hour that doctors spent in direct contact with patients, they spent nearly 2 additional hours on electronic record-keeping and similar clerical work. In addition, physicians in the study who completed after-hours diaries reported 1 to 2 hours of after-hours work each night, devoted mostly to EHR tasks.
The study group cautions that data from their analysis were gathered in self-selected, high-performing practices and may not be generalizable to other settings. The descriptive study design did not support formal statistical comparisons by physician and practice characteristics. That said, the findings do shed light on the issues that physicians appear to face when it comes to time is spent in ambulatory practice.
“Our results indicate that it’s possible that the large amount of time spent on EHRs and other clerical duties may contribute to physician burnout,” Dr. Sinsky says. “The findings suggest a need for documentation assistance to reduce the administrative burden that doctors often face.”
The American Medical Association and the American College of Physicians have launched programs that are designed to help reduce administrative duties for physicians, including toolkits for tasks like team documentation. “These are important programs that physicians should use,” adds Dr. Sinsky. “However, additional support is needed from regulators, policymakers, and EHR developers to create environments that enable doctors to focus more of their efforts on optimizing patient care.”
Christine A. Sinsky, MD, has indicated to Physician’s Weekly that she has worked as a consultant in the past for multiple healthcare delivery organizations and has worked as a paid speaker in the past, receiving honoraria, for multiple healthcare conferences.
Sinsky C, Colligan L, Li L, et al. Allocation of physician time in ambulatory practice: a time and motion study in 4 specialties. Ann Intern Med. 2016 Sep 6 [Epub ahead of print]. Available at: http://annals.org/article.aspx?articleid=2546704.
Hingle S. Electronic health records: an unfulfilled promise and a call to action. Ann Intern Med. 2016 Sep 6 [Epub ahead of print]. Available at: http://annals.org/article.aspx?articleid=2546705.
Friedberg M, Chen PG, Van Busum KR, et al. Factors affecting physician professional satisfaction and their implications for patient care, health systems, and health policy. Santa Monica, Calif.: RAND Corporation, 2013. Available at: www.rand.org/pubs/research_reports/RR439.