Time-pressed physicians spend significantly more time on computer than on direct patient interaction

Internal medicine physicians at a Swiss teaching hospital frequently worked overtime and spent about 3 times as much time using a computer as they did on patients. Most of their time at work was spent on activities indirectly related to patient care. Results of the time and motion study are published in Annals of Internal Medicine.

The structure of a resident's workday has changed dramatically in recent decades, with limitations on hours worked per week, wide implementation of electronic medical records (EMRs), and a growing volume of clinical data and administrative tasks. A recent study found that physicians use about 50 percent of their time using EMRs, but few time and motion studies have focused on how computer use affects resident's time allocation. This is important because less time spent with patients decreases physician satisfaction and patient education and health promotion and increases inappropriate prescribing and medical malpractice.

Researchers sought to objectively assess the type and duration of activities performed by internal medicine residents throughout the day. The primary focus was to estimate the time spent with patients and using a computer. The secondary focus was to identify individual factors influencing residents' allocation of time to different activities and contexts.

Trained observers used a tablet-based application to record and categorize 22 job-related activities for 36 internal medicine residents. They found that most residents worked an average of 1.6 hours longer than the official 10 hours scheduled. After-hours activities consisted mostly of writing in the EMR. Overall, for every hour the residents spent with patients, they spent an average of five hours on other tasks. Activities indirectly related to patients predominated and about half the workday was spent on the computer. The authors suggest that organizational changes and EMR improvements are required to increase efficiency.