Physician time may be the most valuable resource in healthcare, but it’s not being used as well as it could be. Furthermore, it’s difficult to pinpoint precisely where doctors’ time goes during the workday.
A recent study published in the Journal of General Internal Medicine provides data and helpful recommendations about making better use of physician time.
How do physicians spend their work time?
Allocation of physician time directly impacts the quality and cost of healthcare, the patient experience, and doctors’ professional satisfaction.
Recent research has identified more precisely how physician time is allocated throughout the work day. Below are five takeaways relevant for doctors and anyone working to improve healthcare.
1. Doctors still spend most of their time on patient care.
The latest study grouped physician work time into six categories:
- Patient care-related activities – Interacting with a patient or family, communicating with or about patients, planning and reviewing records/results.
- EHR input – Dictating or entering progress notes into the medical record, coding diagnoses, billing, and signing documents.
- Administrative work – Obtaining prior authorizations, reviewing records, preparing reports, and attending meetings.
- Teaching/Supervising (students, residents, or fellows)
- Personal time – Breaks for meals, personal phone calls or emails, and other activities unrelated to patient care.
- Other – Anything not covered above.
Physicians reported spending two-thirds of their time on patient care-related activities. By comparison, just 28% of physician time is spent on administrative work and EHR input only (not including multitasking).
Other studies with different methodologies report that physicians spend less time on patient care. For example, a 2017 publication in Health Affairs said that physicians split their time evenly between seeing patients and what the authors call “desktop medicine.”
2. Physicians spend about half their workday using the EHR.
According to the latest data, doctors spend slightly less than half their work time (45%) interacting with the EHR.
The latest research used a smartphone app to survey 61 primary care physicians, cardiologists, and orthopedists from 28 practices. The app would beep at physicians during random intervals throughout the workday, and participants would respond by clicking on the activity they were engaged in.
Other studies confirm that about half of doctors’ work days are spent using the EHR. For example, research from 2016 found physicians spend 49% of their time on EHR and desk work.
3. EHR time overlaps substantially with patient visits.
Looking more closely at the data, only one-fifth (21%) of physician time is spent solely on EHR input. An additional quarter (24%) is spent using the EHR while interacting with patients. This means that over half of doctors’ EHR time occurs during patient visits.
This finding could be considered good or bad news, but it probably isn’t surprising to anyone who has seen a doctor in the past decade. Most providers try to streamline documentation by checking relevant boxes in the EHR while interviewing patients.
While this type of multitasking can distract attention from the patient, in the best-case scenario, EHR documentation can double as a patient engagement strategy. For example, some providers use mobile dictation to complete clinical notes while repeating care plan details to the patient.
4. Physicians spend a third of their workday multitasking.
In the study that used a beeper to survey physicians randomly throughout their day, respondents could select multiple tasks. Unsurprisingly, doctors often multitask – for example, they input data in the EHR while interacting with a patient or their family.
In total, doctors reported multitasking 32% of the time.
5. Documentation only accounts for a quarter of EHR time.
While doctors spend half their day interacting with the EHR, this fact may be less dire than it seems.
One study found that physicians spend about 16 minutes per encounter using the EHR, but that documentation accounts for just a quarter of that time (4 minutes per visit). Physicians also use the EHR for chart review (33% of EHR time) and ordering (17%).
How to improve physician time allocation
Most physicians believe EHRs contribute to burnout, so it’s discouraging that nearly half of doctors’ work time is spent using EHRs. Still, this finding belies more significant concerns about how healthcare systems allocate physician time.
The authors of the latest study put it simply:
“The fact that physicians – highly-trained professionals whose time is expensive – spend only 66.5% of their time on patient care suggestions that a back-to-the-drawing board approach to time-use by these highly trained professionals might be useful.”
What might it look like to improve how physicians spend their work time?
A primary goal is to reduce EHR time and increase time with patients. Documentation support is one way to do this since physicians who use dictation or a documentation assistant have more direct interaction time with patients.
But health systems must also change how physicians are paid, and care teams distribute tasks. Payment changes should encourage process changes that allow physicians to spend closer to 100% of their time on patient care-related activities.