The gender gap in academic surgery: the electronic health record

The electronic health record (EHR) contributes to burnout, and excessive EHR work impedes productivity. The scope of potential gender discrepancies in EHR burden among surgeons is unclear. Because clinical operations and workflow vary by institution, EHR research must be conducted at multiple centers. Identifying modifiable factors that influence how surgeons use the EHR would support strategies that mitigate gender discrepancies. We hypothesized that gender differences in EHR use would be related to EHR support from clinical team members, patient message volume, and documentation length.

We retrospectively evaluated EHR use by surgeons from multiple specialties in eight departments at a large academic center from January to December 2023. Data about clinical and EHR workload were collected using a provider efficiency tracking tool. These data included the amount of time surgeons spent working in the EHR outside of regular work hours overall and on individual tasks such as responding to messages, clinical review, and orders; the number of messages received and their source; proficiency with documenting in the EHR; and receipt of assistance with EHR documentation and orders from clinical team members.

EHR use was analyzed from 323 surgeons (32% women). After adjusting for specialty, women spent more time than men working in the EHR outside of scheduled clinical hours (mean difference: 7.8 min/day; p = 0.001) and 7 AM to 7 PM (3.8 min/day; p = 0.007) despite no difference in clinical workload. Women spent more time on notes (1.8 min/appointment; p < 0.001), messages (0.7 min/appointment; p = 0.004), and clinical review (0.6 min/appointment; p = 0.032) than men. However, there were no surgeon gender differences in clinical support for EHR work, number of patient messages, note length, or proficiency with the EHR.

Women surgeons had a greater EHR burden than men at our institution. Assuming 16 clinical days/month, 8 min/day of additional EHR work outside of scheduled clinical hours for women translates to approximately 26 h/year of lost time relative to men. Unequal EHR work may increase the gender gap in career advancement and exacerbate burnout for women. Future research should include prospective multi-center trials to clarify the extent of the surgical EHR gender gap.