Canadian-based case studies of PA models of care (Commentaries on health services research)

The authors used a time and motion study (office hours) and self-reported diary (after hours) to describe how time is spent in ambulatory practice. Family medicine, internal medicine, cardiology, and orthopedic physicians were observed. In-office physicians spent 27% of their total time on direct clinical face time with patients and 49% of their time on electronic health records (EHRs) and deskwork. While in the examination room with patients, they spent 53% of the time on direct clinical face time and 37% on EHRs and deskwork. Physicians reported 1 to 2 hours of after-hours work each night, devoted mostly to EHR tasks. For every hour physicians provide direct clinical face time to patients, nearly 2 additional hours is spent on EHRs and deskwork in the clinic day. Outside office hours, physicians spend another 1 to 2 hours of personal time each night doing additional computer and other clerical work.1

Commentary by Roderick S. Hooker: A time and motion study is a business efficiency technique combining the time study work of Frederick Taylor with the motion study work of Frank and Lillian Gilbreth a century ago. This technique remains applicable today in human resource and animal observation investigations.2 Additionally, time-motion data are typically considered highly valued evidence in efficiency research. Jane Record's seminal time-motion study on PAs and supervising physicians in the 1970s remains embedded in medical labor economics as early evidence of team-based synergy.3 What this American Medical Association-sponsored physician time-motion study illustrates is that EHRs are culprits in offsetting patient time with clerical work that consumes twice as much labor. EHRs were not present in early organizational studies of physicians and other health professionals but have now emerged to be the bane of existence for many fatigued providers. This outpatient study validates inpatient observations that what providers perceive they are doing daily differs significantly from what they are systematically observed to be doing.4