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Research ArticleOriginal Research

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 and Mia Zaharna
The Annals of Family Medicine November 2005, 3 (6) 494-499; DOI: https://doi.org/10.1370/afm.391
Valerie Gilchrist
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Gary McCord
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Susan Labuda Schrop
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Bridget D. King
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Kenelm F. McCormick
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Allison M. Oprandi
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Brian A. Selius
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Michael Cowher
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Rishi Maheshwary
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Falguni Patel
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Ami Shah
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Bonny Tsai
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Mia Zaharna
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Article Figures & Data

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    Table 1.

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

    ActivityMinutes 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
        Charting32.9 ± 28.0 (24)28.8—6.7
        Dictating23.4 ± 19.2 (25)20.5—4.8
    Medical activities
        Medical reading and writing18.5 ± 14.8 (13)16.2—3.8
        Medical conversations with nurse/staff16.1 ± 8.0 (14)14.1—3.3
        Medical telephone calls15.0 ± 13.2 (11)13.1—3.1
        Medical conversations with Physicians2.9 ± 3.9 (1)2.5—0.6
        Medical conversations with patient or patient’s family2.6 ± 2.6 (2)2.3—0.5
        Finding or distributing drug samples to patients1.6 ± 3.9 (0)1.4—0.3
        Laboratory work1.1 ± 4.1 (0)1.1—0.2
    Nonmedical activities
        Personal activities30.4 ± 30.4 (22)—39.76.2
        Sales representative meetings8.5 ± 12.6 (3)—11.11.7
        Nonmedical conversations with nurse/staff7.5 ± 7.7 (5)—9.81.5
        Nonmedical telephone calls3.3 ± 4.5 (2)—4.30.7
        Nonmedical conversations with physicians3.0 ± 5.7 (0)—3.90.6
        Teaching4.8 ± 6.2 (2)—6.31.0
        Mail4.6 ± 7.2 (2)—6.00.9
        Staff meetings2.2 ± 11.5 (0)—2.90.5
        Other nonmedical*12.1 ± 18.7 (7)—15.82.5
    Minutes per Day Mean ± SD Minutes per Day Mean ± SD
    Overall time in office
        Out of examination room188.7 ± 59.0 (183)114.2 ± 47.476.5 ± 45.139
        Inside examination room299.7 ± 81.9 (303)299.7 ± 81.9—61
    Total488.4 ± 88.2 (505)——100
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    Table 2.

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

    ActivityActual Time Minutes*Physician- Estimated Time Minutes* t P Value
    *Mean values.
    Direct patient care3003302.12.045
    Charts and dictating56.484.62.92.008
    Reading and writing19.924.60.72.48
    Telephone calls18.426.01.97.06
    Conversations33.537.20.69.497
    Teaching4.89.51.14.27
    Committees and meetings10.73.5−2.47.02
    Other47.020.6−4.21<.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.
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The Annals of Family Medicine: 3 (6)
The Annals of Family Medicine: 3 (6)
Vol. 3, Issue 6
1 Nov 2005
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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
The Annals of Family Medicine Nov 2005, 3 (6) 494-499; DOI: 10.1370/afm.391

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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
The Annals of Family Medicine Nov 2005, 3 (6) 494-499; DOI: 10.1370/afm.391
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