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Analysis

First-Year Docs Spend Work Days Glued to EHR Systems

By John Commins  
   April 22, 2019

A fraction of internal medicine interns' time is spent in face-to-face interactions with patients, and even then they're multitasking.

First-year physicians spend 87% of their work day away from patients, half of which is spent futzing with electronic health records.

Most of the remaining 13% of face time with patients is spent multitasking, according to a new study from Penn Medicine and Johns Hopkins University.

"This objective look at how interns spend their time during the work day reveals a previously hidden picture of how young physicians are trained, and the reality of medical practice today," said lead author Krisda Chaiyachati, MD, an assistant professor of Medicine in the Perelman School of Medicine of the University of Pennsylvania.

"Our study can help residency program leaders take stock of what their interns are doing and consider whether the time and processes are right for developing the physicians we need tomorrow," Chaiyachati said.

The researchers tracked the activities of 80 interns in six internal medicine programs over three months in 2016, gathering data on 194 shifts spanning 2,173 hours.

The activities were classified into categories, including direct patient care, indirect patient care, and education.

Interns spent the most time performing indirect patient care, taking up an average of 15.9 hours of a 24-hour period—almost five times more hours than the next most common activity, direct patient care, which accounted for three hours of the day. Education was the third-highest category of intern time, attributed to 1.8 hours.

Although interns are spending a significant amount of time not interacting directly with patients, Chaiyachati said it's too early to tell "whether or not how interns allocate their time is 'good' or ‘bad.'"

"Indirect patient care has tradeoffs," Chaiyachati said. "If it takes time away to the point that patients feel like we aren’t listening to their needs or we lose out on human interactions that provide physicians with a sense of purpose, that is a bad thing. But if it helps us diagnose diseases more efficiently, then maybe that's not that bad in the end."

When the researchers analyzed four different time periods (separated into six-hour periods: morning, afternoon, evening, and night), they found no significant differences. But multitasking was common throughout.

Roughly 25% of interns' time interacting with patients occurred at the same time as coordinating care or updating medical records.

"Increased multitasking is a side effect of our current system," Chaiyachati said. "It's not simply that we are doing more work or we have more tasks in our day-to-day. We are trying to do more in a fixed amount of time."

Chaiyachati said the study can provide an important baseline that training programs and hospitals may use when adjusting programs, shifting responsibility for tasks to other healthcare providers, or automating processes.

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The study, published this month in JAMA Internal Medicine, is a part of a larger effort called the Individualized Comparative Effectiveness of Models Optimizing Patient Safety and Resident Education (iCOMPARE) study.

The multi-year study, funded by the National Institute of Health and the Accreditation Council for Graduate Medical Education, seeks to better understand the effects of shift lengths on young doctors and their patients.

Last month, two other studies published in the New England Journal of Medicine from iCOMPARE showed that first-year doctors did not experience chronic sleep loss nor was patient safety affected when doctors-in-training were allowed to work longer shifts than had previously been permitted by the ACGME

“Increased multitasking is a side effect of our current system. It's not simply that we are doing more work or we have more tasks in our day-to-day. We are trying to do more in a fixed amount of time.”

John Commins is a senior editor at HealthLeaders.

Photo credit: Jamesboy Nuchaikong / Shutterstock


KEY TAKEAWAYS

Interns spent the most time performing indirect patient care, taking up an average of 15.9 hours of a 24-hour period—almost five times more hours than the next most common activity, direct patient care, which accounted for three hours of the day.

Education was the third-highest category of intern time, attributed to 1.8 hours.


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