Primary care physicians spent a median of 61.8 hours per week on patient care, based on data from 33 clinics in a large integrated health system. Each full-time equivalent physician devoted about 2,844 hours annually, which averaged 1.7 hours per patient per year, and physicians in the highest quartile of message volume spent about 28 additional minutes per patient annually compared with those in the lowest quartile.
The researchers reported that these 2,844 yearly and 62 weekly median hours exceeded prior estimates of a 43-hour work week for family physicians and a 51-hour work week for primary care physicians in general. They noted that this may be due to additional time spent on electronic health record (EHR) tasks introduced over the past decade and a half. However, these estimates remained substantially lower than the 26.7 hours per day that are theoretically required for physicians to provide all preventive, chronic disease, and acute care recommended for a typical panel. The discrepancy, according to the researchers, reflects that many primary care needs are going unmet given current reimbursement models and the organization of care in the United States. The researchers also noted that time expenditure per patient was unlikely to decrease proportionally even when physicians reduced their clinical hours, due to the longitudinal and continuous nature of primary care demands.
Further, they found that part-time physicians spent more time per patient than full-time physicians after accounting for clinical effort. Those who worked less than 0.5 clinical full-time equivalent (cFTE) spent a median of 2 hours per patient yearly, compared with 1.5 hours among physicians who worked 0.75 to 1.25 cFTE. Median yearly work effort per 1 cFTE ranged from 3,480.8 hours for physicians with a cFTE less than 0.5 to 2,401.5 hours for those with a cFTE of 0.75 to 1.25.
Workload varied with patient and practice factors. Panels with older or more medically complex patients, greater proportions of Medicaid coverage, or higher patient-message volumes required more time. Additional findings showed that panels with a greater proportion of female patients were linked to higher yearly time expenditure, while those practicing in community health centers spent less time per patient. The findings also indicated that work effort was influenced by additional factors beyond patient panel or clinic characteristics, such as the longitudinal demands of ongoing patient management, increased asynchronous communication, and administrative tasks not captured within standard visit time.
“In an era of increased asynchronous communication with patients, the volume of patient messages requesting medical advice is an additional factor associated with differential time expenditure,” wrote Lisa S. Rotenstein, MD, MBA, of the Department of Medicine at the University of California, San Francisco, and colleagues. They noted that the lesser yearly time expenditure by physicians in community health centers warrants further investigation.
The study included 406 attending physicians practicing in 2021. The researchers combined electronic health record (EHR) logs, administrative data, and middle time bounds of evaluation and management codes to estimate appointment duration and total annual work hours. Time estimates were adjusted for practice-level clustering and controlled for patient age, comorbidity, insurance, and message volume. Results were limited to a single health system and may not represent other practice settings. EHR logs may have undercounted work completed outside the digital platform, and variations in staffing or documentation were not measured.
Full disclosures can be found in the published study.
Source: Annals of Internal Medicine