How many hours a day do you typically work?

I’m not just talking about seeing patients, although that’s included. I’m also thinking about all the time spent reviewing tests, filling out forms, returning calls, refilling meds, talking to your staff about what needs to be done for the patients who called with questions or problems, and (a big one) dictating and charting notes for the day.

I’m going to bet it’s a whole lot more than the time you spent seeing patients.

Sadly, the issue appears to be getting worse. A recent study in Annals of Internal Medicine found that for every hour you spend seeing patients, you’re spending another 2 hours working on the computer EHR doing ancillary stuff for the visits. I’m pretty sure insurance companies aren’t paying for that time.

That’s just in the office. The same study found most of us spend another 1-2 hours of our home time each night doing more office work to finish up what we didn’t get done during the day. So much for that work-life balance we hear so much about.

Ready for the breakdown? Here it is:

• Percentage of the total office day spent with patients = 27%

• Percentage of the total office day spent on charting and other EHR-related tasks = 49%

That’s just overall. Now let’s look at the time you’re actually with the patient in an exam room:

• Face-to-face with patient = 53%

• Time on the computer = 37%

So even in a room with a patient in front of you, over one-third of the time is still spent on the computer.

The degree of drudgery is surprising, too. How many mouse clicks are needed, in one system, to order and record a flu shot? Take a guess. 5? 10? 15? How about 32. Yeah, you read that right. No wonder your index finger hurts.

But let’s go back to the main point here, that 1 hour of patient time equals 2 hours of computer time ratio. At its core, it suggests that in order to get everything done, you should only be seeing patients for 3 hours a day because you’ll need at least another 6 hours to get all the computer stuff for them done. You think you can make a living, or even pay your overhead, billing for 3 hours of patient time a day? Me neither. I need to put in at least 8 hours of patient time, which means another 16 hours or so of computer time crammed in somewhere, overflowing into evenings and weekends. There are, quite literally, not enough hours in the day to practice good medicine and still get all the ancillary work done quickly and correctly.

With this kind of formula it’s only a matter of time before people get hurt. And the bean counters who run many medical practices these days will never see that aspect of medicine. The more patients, the more revenue, in their minds.

Rather than making life easier for us, EHRs have taken things the opposite way. In a profession where face-to-face time is the most critical part of what we do and the center of the doctor-patient relationship, it’s now second to face-to-screen time. That can’t be good for those who need our help.

Dr. Block has a solo neurology practice in Scottsdale, Ariz.


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