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Time Spent in Face-to-Face Patient Care and Work Outside the Examination Room

¹ Case Western Reserve University School of Medicine, Cleveland, Ohio
² Departments of Family Medicine and Epidemiology and Biostatistics, Case Western Reserve University, and the Case Comprehensive Cancer Center, Cleveland, Ohio

CORRESPONDING AUTHOR: Susan Flocke, PhD, 11001 Cedar Ave, Suite 306, Cleveland, OH 44106-7136, susan.flocke{at}case.edu

PURPOSE Contrary to physicians’ concerns that face-to-face patient time is decreasing, data from the National Ambulatory Medical Care Survey (NAMCS) indicate that between 1988 and 1998, durations of primary care outpatient visits have increased. This study documented how physicians spend time during the workday, including time outside the examination room, and compared observed face-to-face patient care time with that reported in NAMCS.

METHODS Using time-motion study techniques, for each of 11 physicians, 2 patient care days were randomly selected and documented by direct observation. Physician time spent on face-to-face patient care and 54 activities outside the examination room were documented. Data represent 12,180 minutes of work and 611 outpatient visits.

RESULTS The average workday duration was 8.6 hours, and face-to-face patient care accounted for 55% of the day. Work outside the examination room relevant to a patient currently being seen averaged 14% of the day. Work related to a patient not physically present accounted for one fifth (23%) of the workday. The combination of face-to-face time and time spent on visit-specific work outside the examination room assessed by direct observation was significantly less than the 2003 NAMCS estimate of visit duration assessed by physician report (13.3 vs 18.7 minutes, P <.001).

CONCLUSIONS Nearly one half of a primary care physician’s workday is spent on activities outside the examination room, predominately focused on follow-up and documentation of care for patients not physically present. National estimates of visit duration overestimate the combination of face-to-face time and time spent on visit-specific work outside the examination room by 41%.

Key Words: Direct observation • primary care • time factors • time and motion study • office visits

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