Skip to content
  • About
  • Contact
  • Contribute
  • Book
  • Careers
  • Podcast
  • Recommended
  • Speaking
  • All
  • Physician
  • Practice
  • Policy
  • Finance
  • Conditions
  • .edu
  • Patient
  • Meds
  • Tech
  • Social
  • Video
    • All
    • Physician
    • Practice
    • Policy
    • Finance
    • Conditions
    • .edu
    • Patient
    • Meds
    • Tech
    • Social
    • Video
    • About
    • Contact
    • Contribute
    • Book
    • Careers
    • Podcast
    • Recommended
    • Speaking

Does the amount of interns’ time spent in direct patient care matter?

Paul Bergl, MD
Education
September 25, 2013
Share
Tweet
Share

Recently in NEJM Journal Watch General Medicine, Abigail Zuger reviewed an article from the Journal of General Internal Medicine in which researchers examined how medical interns spend their time. The results from this time motion study might be concerning but are not unexpected. The investigators found that interns on inpatient rotations spend only 12% of their time in direct patient care and spend only 8 minutes daily with each patient on their inpatient services. Dr. Zuger notes this “distressing paucity” of direct patient care should cause leaders in graduate medical training to effect change in interns’ daily routines.

To those of us in training or just out of training, the reasons for less direct patient care are myriad and obvious:

  • A focus on multidisciplinary care and ever-increasing specialization results in each medical patient having a dozen or more physicians, consultants, nurses, pharmacists, case managers, social workers, and therapists directly involved in care. At this core of this legion of providers stands the intern. This novice physician must field messages, pages, and advice from all arms of the treatment team. As such, the intern spends as much time coordinating care as he or she spends relaying messages and answering “quick questions” — which are never quick and rarely are questions.
  • Patient acuity in academic centers also continues to rise. Patients on medical wards often are admitted with multiple comorbidities and in a state of disarray. Rare are the relatively straightforward admissions for uncomplicated pneumonia or CHF exacerbation. Thus, interns have to manage a number of active conditions, complex medication lists, and a barrage of patient data.
  • In addition, the Centers for Medicare and Medicaid pay us by DRGs and have also inculcated us to prevent 30-day readmissions. CMS will soon ask us to admit more patients to observation status. How do all of these shifts in payment affect a house officer? The intern has to spend all the more time ensuring safe and timely discharges. Tasks like medication reconciliations and communicating with outpatient providers suck up even more of the intern’s day at the expense of face time with the patient.
  • Finally, documentation steals many a precious minute from the day. The considerations of patient acuity and reimbursement add to the burden of documentation leading to bloated notes that take far too much time to construct.

I am probably too young to be so cynical, but I do not see a shift in these routines occurring any time soon. And without be excessively cantankerous, I feel obligated to ask, “Does the percentage of interns’ time spent in direct patient care matter?”

An smaller percentage of interns’ time spent directly interfacing with patients may not mean that patients get worse care. We don’t have any direct data that the distressing paucity of direct patient care is resulting in poor outcomes. Moreover, the very “non-patient” tasks outlined above are entirely necessary in today’s inpatient environment. For example, if a patient is started on a LMWH bridge to warfarin in the hospital, figuring out how the LMWH will be paid for and who will follow the INR post-hospitalization is as important as time spent at the patient’s bedside.

Of course, I am not suggesting that intern work is inherently rewarding or educational. Most of us embark on this career path because we value interaction with actual human beings, not because we like electronic note templates. I myself romance about the days when internists actually took the time to perform thorough histories and physicals. But if we don’t encumber the interns with all of this work, who will do it?

Paul Bergl is an internal medicine physician who blogs at Insights on Residency Training, a part of Journal Watch.

Prev

The time to get flu shots is now

September 25, 2013 Kevin 8
…
Next

Unregulated gun access and its drain on medical resources

September 25, 2013 Kevin 33
…

Tagged as: Residency

Post navigation

< Previous Post
The time to get flu shots is now
Next Post >
Unregulated gun access and its drain on medical resources

ADVERTISEMENT

ADVERTISEMENT

ADVERTISEMENT

More by Paul Bergl, MD

  • a desk with keyboard and ipad with the kevinmd logo

    Teaching doctors: Learning to learn in new ways

    Paul Bergl, MD
  • a desk with keyboard and ipad with the kevinmd logo

    Will resident autonomy disappear completely in the future?

    Paul Bergl, MD
  • a desk with keyboard and ipad with the kevinmd logo

    Prevention, detection, and treatment of cancer has become more nuanced

    Paul Bergl, MD

More in Education

  • How dismantling DEI endangers the future of medical care

    Shashank Madhu and Christian Tallo
  • What’s driving medical students away from primary care?

    ​​Vineeth Amba, MPH, Archita Goyal, and Wayne Altman, MD
  • In the absence of physician mentorship, who will train the next generation of primary care clinicians?

    Kenneth Botelho, DMSc, PA-C
  • The moment I knew medicine needed more than science

    Vaishali Jha
  • A faster path to becoming a doctor is possible—here’s how

    Ankit Jain
  • Medical students in Korea face expulsion for speaking out

    Anonymous
  • Most Popular

  • Past Week

    • What’s driving medical students away from primary care?

      ​​Vineeth Amba, MPH, Archita Goyal, and Wayne Altman, MD | Education
    • How scales of justice saved a doctor-patient relationship

      Neil Baum, MD | Physician
    • Make cognitive testing as routine as a blood pressure check

      Joshua Baker and James Jackson, PsyD | Conditions
    • The dreaded question: Do you have boys or girls?

      Pamela Adelstein, MD | Physician
    • The broken health care system doesn’t have to break you

      Jessie Mahoney, MD | Physician
    • The hidden cost of delaying back surgery

      Gbolahan Okubadejo, MD | Conditions
  • Past 6 Months

    • What’s driving medical students away from primary care?

      ​​Vineeth Amba, MPH, Archita Goyal, and Wayne Altman, MD | Education
    • Internal Medicine 2025: inspiration at the annual meeting

      American College of Physicians | Physician
    • What happened to real care in health care?

      Christopher H. Foster, PhD, MPA | Policy
    • Residency as rehearsal: the new pediatric hospitalist fellowship requirement scam

      Anonymous | Physician
    • Are quotas a solution to physician shortages?

      Jacob Murphy | Education
    • A faster path to becoming a doctor is possible—here’s how

      Ankit Jain | Education
  • Recent Posts

    • A female doctor’s day: exhaustion, sacrifice, and a single moment of joy

      Dr. Damane Zehra | Physician
    • Addressing America’s reliance on psychotropic medication [PODCAST]

      The Podcast by KevinMD | Podcast
    • The hidden cost of malpractice: Why doctors are losing control

      Howard Smith, MD | Physician
    • How scales of justice saved a doctor-patient relationship

      Neil Baum, MD | Physician
    • Rediscovering the soul of medicine in the quiet of a Sunday morning

      Syed Ahmad Moosa, MD | Physician
    • An introduction to occupational and environmental medicine [PODCAST]

      The Podcast by KevinMD | Podcast

Subscribe to KevinMD and never miss a story!

Get free updates delivered free to your inbox.


Find jobs at
Careers by KevinMD.com

Search thousands of physician, PA, NP, and CRNA jobs now.

Learn more

View 4 Comments >

Founded in 2004 by Kevin Pho, MD, KevinMD.com is the web’s leading platform where physicians, advanced practitioners, nurses, medical students, and patients share their insight and tell their stories.

Social

  • Like on Facebook
  • Follow on Twitter
  • Connect on Linkedin
  • Subscribe on Youtube
  • Instagram

ADVERTISEMENT

ADVERTISEMENT

ADVERTISEMENT

ADVERTISEMENT

  • Most Popular

  • Past Week

    • What’s driving medical students away from primary care?

      ​​Vineeth Amba, MPH, Archita Goyal, and Wayne Altman, MD | Education
    • How scales of justice saved a doctor-patient relationship

      Neil Baum, MD | Physician
    • Make cognitive testing as routine as a blood pressure check

      Joshua Baker and James Jackson, PsyD | Conditions
    • The dreaded question: Do you have boys or girls?

      Pamela Adelstein, MD | Physician
    • The broken health care system doesn’t have to break you

      Jessie Mahoney, MD | Physician
    • The hidden cost of delaying back surgery

      Gbolahan Okubadejo, MD | Conditions
  • Past 6 Months

    • What’s driving medical students away from primary care?

      ​​Vineeth Amba, MPH, Archita Goyal, and Wayne Altman, MD | Education
    • Internal Medicine 2025: inspiration at the annual meeting

      American College of Physicians | Physician
    • What happened to real care in health care?

      Christopher H. Foster, PhD, MPA | Policy
    • Residency as rehearsal: the new pediatric hospitalist fellowship requirement scam

      Anonymous | Physician
    • Are quotas a solution to physician shortages?

      Jacob Murphy | Education
    • A faster path to becoming a doctor is possible—here’s how

      Ankit Jain | Education
  • Recent Posts

    • A female doctor’s day: exhaustion, sacrifice, and a single moment of joy

      Dr. Damane Zehra | Physician
    • Addressing America’s reliance on psychotropic medication [PODCAST]

      The Podcast by KevinMD | Podcast
    • The hidden cost of malpractice: Why doctors are losing control

      Howard Smith, MD | Physician
    • How scales of justice saved a doctor-patient relationship

      Neil Baum, MD | Physician
    • Rediscovering the soul of medicine in the quiet of a Sunday morning

      Syed Ahmad Moosa, MD | Physician
    • An introduction to occupational and environmental medicine [PODCAST]

      The Podcast by KevinMD | Podcast

MedPage Today Professional

An Everyday Health Property Medpage Today
  • Terms of Use | Disclaimer
  • Privacy Policy
  • DMCA Policy
All Content © KevinMD, LLC
Site by Outthink Group

Does the amount of interns’ time spent in direct patient care matter?
4 comments

Comments are moderated before they are published. Please read the comment policy.

Loading Comments...