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Doctors, nurse practitioners and physician assistants who work as primary care providers have always been busy and through much of the history of modern medicine, that busy-ness was balanced by a high level of job satisfaction, well above average compensation, and a position of esteem in society.

But over the past decade that balance has been lost.  Health care providers, while still well respected, have lost some esteem from those we serve.  Compensation remains very good, but salaries for primary care specialties (family medicine, pediatrics and internal medicine) are among the lowest for physicians.   And now over 50% of family doctors suffer from burnout (loss of energy and empathy).  This is becoming a work force crisis and a lamentable loss for many of us who feel called to this work.  What went wrong?  One important clue is to look at how we spend our work time.

New research recently published in the Annals of Internal Medicine reveal  that our primary care workdays have become distorted.  Basically, for every hour primary care providers (PCPs) spend in face-to-face time with patients, they spend 2 hours working in documentation tasks, paperwork and work in the electronic health record (EHR).  This is how it breaks down for each day that we work providing primary care:

  • We spend 27% of our time in exam rooms, with patients.
  • We spend 49% of our time working on deskwork and documentation the EHR.
  • While we are actually in the exam room, we only spend 53% of our time talking with and examining the patient.  The rest of our time is spent working on documentation and other tasks.  So that really means that only about 14% of our time each day is spent directly interacting with our patients.

In addition to these very serious challenges we know that many PCPs also spend time at home completing their documentation each day.  This unrelenting time pressure, time spent doing work that we do not enjoy and time lost from that which motivates us and is a key source of resiliency (taking care of our patients) is at the root of our challenge in primary care.

As we work to transform the way we deliver primary care there is no doubt that PCPs will need to spend more time developing and managing treatment plans for our patients, and leading a team that helps to ensure that the panel of patients for whom we are responsible are staying as well as possible, and that new role will mean less traditional face-to-face time with patients.  But we will still spend most of our day caring for patients in our offices, and we must work to find sustainable models that allow us to be more present for our patients and to gain back our time to care for them in a way that improves outcomes, improves our patients’ experience of care, and once again becomes a source of energy and resiliency for those of us providing that care, by fulfilling the very motivation that drives us to do this important work.

Some examples from the study:

  • Physicians (this was the only group that was studied in this research) with dictation support averaged 31% face-to-face time, compared to the average of 27%.
  • Physicians with a documentation assistant (scribe) averaged 44% face-to-face time with patients.
  • Those with no documentation support averaged only 23% face-to-face time with patients.

Obviously these resources cost money and building and spreading a model that provides this kind of support must be done carefully and responsibly.  There may also be other areas which help to address our time imbalance, such as coding support and increasing clinical support staff.  What is clear is that we must attend to this challenge and work together to find impactful and sustainable solutions, so that we have an engaged and energized primary care work force to serve our patients in the future.

Noah Nesin, MD

Dr. Nesin, Vice President of Medical Affairs for PCHC, is a family doctor with 30 years of experience.

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