First-year doctors spend 3 times more hours on EHRs than patient care

First-year residents, or interns, spend nearly 90% of their work time away from patients, half of which is spent interacting with electronic health records and documentation, according to a new study.

Interns spend approximately 13% of their time, or three hours during a 24-hour time period, interacting with patients face-to-face during a typical day, and yet much of that is still spent multitasking, according to researchers from Penn Medicine and Johns Hopkins University whose study was recently published in JAMA Internal Medicine.

Roughly 25% of interns' time interacting with patients occurred at the same time as coordinating care or updating medical records, the study found.

First-year residents spend 66% of their time, nearly 16 hours, on indirect patient care. That's almost five times more hours on indirect patient care than on face-to-face patient care. Most of that time, 10.3 hours, was spent on interacting with EHRs. In addition, interns spent close to six hours a day communicating with team members and 3.3 hours communicating with non-team members.

Interns only spent 1.8 hours, or 7% of their time, on education, including studying and time spent being taught while in the hospital, and five hours, about 20% of their time, doing rounds.

According to the researchers, it’s the largest study to look at how first-year doctors spend their workday with the aim of gaining a better understanding of what medical residents did while in training, such as how much time they spent in education and patient care.

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“This objective look at how interns spend their time during the workday reveals a previously hidden picture of how young physicians are trained, and the reality of medical practice today,” the study’s lead author Krisda Chaiyachati, M.D., an assistant professor of medicine in the Perelman School of Medicine of the University of Pennsylvania, said in a news release.

“Our study can help residency program leaders take stock of what their interns are doing and consider whether the time and processes are right for developing the physicians we need tomorrow," Chaiyachati said.

The research is a part of a larger effort known as the Individualized Comparative Effectiveness of Models Optimizing Patient Safety and Resident Education (iCOMPARE) study. This multi-year study, funded by the National Institutes of Health (NIH) and the Accreditation Council for Graduate Medical Education (ACGME), examines the effects of shift lengths on young doctors and their patients.

Although the study found interns are spending a significant amount of time not interacting directly with patients, Chaiyachati said it's too early to tell "whether or not how interns allocate their time is good or bad.” That could come with further research into how time spent on these shifts affects patient care or physician well-being, he said.

"Indirect patient care has tradeoffs," Chaiyachati said. "If it takes time away to the point that patients feel like we aren't listening to their needs or we lose out on human interactions that provide physicians with a sense of purpose, that is a bad thing. But if it helps us diagnose diseases more efficiently, then maybe that's not that bad in the end."

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For this latest study, researchers analyzed data from six different internal medicine programs that took part in the national iCOMPARE study. Researchers recorded the activities of 80 interns over three months in 2016, gathering data on 194 shifts spanning 2,173 hours.

With regard to time interns spend multitasking even when interacting with patients, Chaiyachati said increased multitasking may be a side effect of the current healthcare system. “It's not simply that we are doing more work or we have more tasks in our day-to-day. We are trying to do more in a fixed amount of time,” he said.

According to researchers, the study can provide an important baseline for training programs and hospitals to use when adjusting programs, shifting responsibility for tasks to other health care providers or automating processes.

The amount of time residents spend working has been a controversial topic. In 2011, the ACGME imposed a limit on the number of hours first-year residents could work in a single shift—a cap of 16 hours per day and 80 hours per week. Those changes came in response to concerns about the potential for mistakes to be made by young doctors working long shifts.

In 2017, ACGME reversed its policies and relaxed shift limits to permit interns to work for 24-hour shifts.

Two studies published in the New England Journal of Medicine last month using iCOMPARE data showed that first-year doctors did not experience chronic sleep loss nor was patient safety affected when residents were allowed to work longer shifts, according to a press release.