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Ann Intern Med. 2016 Dec 6;165(11):753-760. doi: 10.7326/M16-0961. Epub 2016 Sep 6.

Allocation of Physician Time in Ambulatory Practice: A Time and Motion Study in 4 Specialties.

Author information

1
From the American Medical Association, Chicago, Illinois; Sharp End Advisory, Hanover, New Hampshire; Australian Institute of Health Innovation, Macquarie University, Sydney, Australia; and Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire.

Abstract

Background:

Little is known about how physician time is allocated in ambulatory care.

Objective:

To describe how physician time is spent in ambulatory practice.

Design:

Quantitative direct observational time and motion study (during office hours) and self-reported diary (after hours).

Setting:

U.S. ambulatory care in 4 specialties in 4 states (Illinois, New Hampshire, Virginia, and Washington).

Participants:

57 U.S. physicians in family medicine, internal medicine, cardiology, and orthopedics who were observed for 430 hours, 21 of whom also completed after-hours diaries.

Measurements:

Proportions of time spent on 4 activities (direct clinical face time, electronic health record [EHR] and desk work, administrative tasks, and other tasks) and self-reported after-hours work.

Results:

During the office day, physicians spent 27.0% of their total time on direct clinical face time with patients and 49.2% of their time on EHR and desk work. While in the examination room with patients, physicians spent 52.9% of the time on direct clinical face time and 37.0% on EHR and desk work. The 21 physicians who completed after-hours diaries reported 1 to 2 hours of after-hours work each night, devoted mostly to EHR tasks.

Limitations:

Data 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.

Conclusion:

For every hour physicians provide direct clinical face time to patients, nearly 2 additional hours is spent on EHR and desk work within the clinic day. Outside office hours, physicians spend another 1 to 2 hours of personal time each night doing additional computer and other clerical work.

Primary Funding Source:

American Medical Association.

PMID:
27595430
DOI:
10.7326/M16-0961
[Indexed for MEDLINE]
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