Physician Activities During Time Out of the Examination Room

Valerie Gilchrist; Gary McCord; Susan Labuda Schrop; Bridget D. King; Kenelm F. McCormick; Allison M. Oprandi; Brian A. Selius; Michael Cowher; Rishi Maheshwary; Falguni Patel; Ami Shah; Bonny Tsai; Mia Zaharna

doi:10.1370/afm.391

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Table 1.

Time Spent on Activities Out of the Examination Room (N = 27 Family Physicians)

Activity	Minutes per Day Mean ± SD (Median)	Medical Time Out of Examination Room %	Nonmedical Time Out of Examination Room %	Total Time in Office %
*A collection of low-frequency nonmedical activities (eg, nonmedical reading, nonmedical patient conversation, sales representative telephone calls, adjusting thermostat, research, faxing, sitting at desk, washing laboratory coat, nonmedical computer work, waiting for patient to arrive at office, moving furniture, searching for personal digital assistant, touring the site with student, typing a nonmedical letter, washing hands before lunch).
Medical documentation
Charting	32.9 ± 28.0 (24)	28.8	—	6.7
Dictating	23.4 ± 19.2 (25)	20.5	—	4.8
Medical activities
Medical reading and writing	18.5 ± 14.8 (13)	16.2	—	3.8
Medical conversations with nurse/staff	16.1 ± 8.0 (14)	14.1	—	3.3
Medical telephone calls	15.0 ± 13.2 (11)	13.1	—	3.1
Medical conversations with Physicians	2.9 ± 3.9 (1)	2.5	—	0.6
Medical conversations with patient or patient’s family	2.6 ± 2.6 (2)	2.3	—	0.5
Finding or distributing drug samples to patients	1.6 ± 3.9 (0)	1.4	—	0.3
Laboratory work	1.1 ± 4.1 (0)	1.1	—	0.2
Nonmedical activities
Personal activities	30.4 ± 30.4 (22)	—	39.7	6.2
Sales representative meetings	8.5 ± 12.6 (3)	—	11.1	1.7
Nonmedical conversations with nurse/staff	7.5 ± 7.7 (5)	—	9.8	1.5
Nonmedical telephone calls	3.3 ± 4.5 (2)	—	4.3	0.7
Nonmedical conversations with physicians	3.0 ± 5.7 (0)	—	3.9	0.6
Teaching	4.8 ± 6.2 (2)	—	6.3	1.0
Mail	4.6 ± 7.2 (2)	—	6.0	0.9
Staff meetings	2.2 ± 11.5 (0)	—	2.9	0.5
Other nonmedical*	12.1 ± 18.7 (7)	—	15.8	2.5
		Minutes per Day Mean ± SD	Minutes per Day Mean ± SD
Overall time in office
Out of examination room	188.7 ± 59.0 (183)	114.2 ± 47.4	76.5 ± 45.1	39
Inside examination room	299.7 ± 81.9 (303)	299.7 ± 81.9	—	61
Total	488.4 ± 88.2 (505)	—	—	100

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Table 2.

Physician Estimates Compared With Actual Time Spent on Various Activities (N = 25 Family Physicians)

Activity	Actual Time Minutes*	Physician- Estimated Time Minutes*	t	P Value
*Mean values.
Direct patient care	300	330	2.12	.045
Charts and dictating	56.4	84.6	2.92	.008
Reading and writing	19.9	24.6	0.72	.48
Telephone calls	18.4	26.0	1.97	.06
Conversations	33.5	37.2	0.69	.497
Teaching	4.8	9.5	1.14	.27
Committees and meetings	10.7	3.5	−2.47	.02
Other	47.0	20.6	−4.21	<.001

Additional Files

Tables

Supplemental Appendixes

Appendix 1. Behavioral Checklist; Appendix 2. Physician Questionnaire.

Files in this Data Supplement:

Supplemental data: Appendix 1 - PDF file, 2 pages, 73 KB
Supplemental data: Appendix 2 - PDF file, 1 page, 56 KB
The Article in Brief

Physician Activities During Time Out of the Examination Room

Valerie Gilchrist, MD , and colleagues

Background The limited time available for medical visits can be a source of frustration for patients and doctors. Doctors must divide their office time between direct patient care and other administrative and communication responsibilities. This study set out to learn more about how practicing primary care doctors spend their office time.

What This Study Found On average, doctors in this study spend 8 hours and 8 minutes in the office per day and have 20 patient visits. Visits last an average of 17.5 minutes. Doctors spend 23 percent of the office day on medical activities other than patient visits, including completing patient charts, dictating medical notes, reviewing reports, consulting medical resources, consulting colleagues, and communicating with patients. This does not include time spent delivering medical care in other settings, such as hospitals, nursing homes, or emergency rooms.

Implications

If out-of- examination room medical care activities were considered part of the patient visit, visit time would increase by about 7 minutes, or 40%. This does not include the many other responsibilities doctors perform outside the office.
Medical care activities outside the examination room reflect the complexity of managing primary care patients; however, patients and payers often do not recognize this care.
To help ensure high-quality care and satisfaction, medical policy and reimbursement should reflect the actual work performed by clinicians.