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Primary Care Physician Time Spent in Patient Care: An Observational Study Using Electronic Health Record Logs
Lisa S Rotenstein1, Michelle Frits2, Christine Iannaccone2
1Division of Clinical Informatics and Digital Transformation and Division of General Internal Medicine, University of California at San Francisco, San Francisco, California, and Division of General Internal Medicine, Brigham and Women's Hospital, Boston, Massachusetts (L.S.R.).
Background:
Given a marked expansion in the work of primary care in recent decades, it is critical to have an accurate understanding of the time involved in managing a primary care panel and the determinants of this time.
Objective:
To estimate the yearly work effort involved for primary care physicians (PCPs) in caring for a patient panel, explore how work effort varies by clinical full-time equivalent (cFTE) status, and identify patient panel factors associated with differential time expenditure.
Design:
Cross-sectional, observational study using electronic health record and administrative data scaled by a literature-based estimate of activities inadequately captured by these data sources.
Setting:
33 clinics in the Mass General Brigham health system.
Participants:
406 attending PCPs who delivered care for at least 9 months in 2021.
Measurements:
Total yearly time expenditure per patient and full-time PCP.
Results:
The median work effort for a full-time PCP was 2844.3 yearly hours (IQR, 2324.9 to 3478.9 yearly hours), or 61.8 weekly hours (IQR, 50.5 to 75.6 weekly hours), for a 1.0-cFTE physician assuming a 46-week work year. This translates to a median of 1.7 hours (IQR, 1.4 to 2.2 hours) per patient per year. Part-time PCPs spent more time per patient on average than full-time PCPs. Patient medical advice request volume and certain panel characteristics, including greater average age, medical complexity, and percentage of patients with Medicaid, were associated with greater yearly PCP time expenditure per patient.
Limitation:
Derivation of data from a single integrated health system and lack of information about practice structures and staff supports for PCPs.
Conclusion:
Primary care physicians spend a median of 62 weekly hours caring for a patient panel. Panel characteristics and patient message volume are associated with time expenditure. These findings provide valuable insights for designing sustainable primary care roles and adjusting panel size expectations.
Primary Funding Source:
The Physicians Foundation.
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