The television doctors: Striding purposefully through the ER, giving orders, surrounded by a gaggle of eager learners and a super-team of nurses and techs. Or spending hours operating, then sipping martinis while waiting for the next disaster. Maybe saving lives in between daydreams and liaisons with hot colleagues and nurses. All in a day’s work!
Maybe not. A new study looked at what doctors really do all day. In the real world, there’s precious little time for striding, martinis, or even a quick trip to the bathroom. In the real world, docs spend most of their time doing paperwork and data entry. That’s hardly sexy, and not even remotely fun, and — gasp — not really what we were trained to do.
From the Annals of Internal Medicine comes a downright depressing study: “Allocation of Physician Time in Ambulatory Practice: A Time and Motion Study in 4 Specialties.” The researchers had medical students (hopefully they were paid) follow 57 U.S. physicians in 4 different specialties in 4 different cities for a total of 430 observation hours. These physicians were all observed during their office hours (excluding time in the hospitals and operating rooms).
Observers used a technique called The Work Observation Method By Activity Timing — I mention this only because it’s abbreviated WOMBAT — to track exactly what the docs did all day. Categories included things like clinical time (either talking or interacting with patients, or talking with staff about matters directly related to a patient), desk work, time spent documenting on an electronic health record, and administrative time. They even recorded “personal time” including bathroom breaks and eating. (Many of the medical students, I think, were surprised that doctors are even allowed to use the bathroom. Ha!) Separately, they had a few dozen of the physician participants fill out diaries to see what they’re up to in the evenings.
The painful results: Doctors, overall, spend about 33 percent of their net workday actually taking care of and interacting with patients. For every hour of direct patient care activity, two hours are spent on typing, data entry, and paperwork. Over the course of an entire workday, we spend only about half of our time in exam rooms, but even while in the exam rooms we’re focusing on and interacting with actual patients about half of that time. Just as much exam-room time is spent typing or dictating into our computers as spent talking with and examining patients.
And, after the work day is over, doctors spend an average of 1.5 hours working from home, spending most of this time on — you guessed it — more data entry into electronic medical records.
Old school: “Mommy, I want to be a doctor!”
Modern equivalent: “Mommy, I want to type and click boxes and fill out forms!”
I’m imagining medical school deans, with this study in mind, are hastily adjusting the curriculum. Gone is biochemistry, replaced with “Sports forms, basic and advanced.” Physiology can become, “Navigating disability and FMLA paperwork,” perhaps with a “disabled parking permit seminar.”
The surgical clerkship can become “Type, click, backspace, repeat,” and all of obstetrics and gynecology can become “Prior authorization jujitsu.” This will surely prepare the next generation of medical students (nurses, too!) for what’s to come. If anyone still wants to do it. We’ll leave the light on when we leave, just in case.
Roy Benaroch is a pediatrician who blogs at the Pediatric Insider. He is also the author of A Guide to Getting the Best Health Care for Your Child and the creator of The Great Courses’ Medical School for Everyone: Grand Rounds Cases.
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