Clinical Edge

Summaries of Must-Read Clinical Literature, Guidelines, and FDA Actions

Physician Time Allocation in Ambulatory Practice

Ann Intern Med; 2016 Dec 6; Sinsky, Colligan, et al

For each hour US physicians provide direct clinical time to patients, nearly 2 additional hours are spent on electronic health record (EHR) and related desk work within a clinic day in 4 designated specialties, a recent study found. 57 US physicians in family medicine, internal medicine, cardiology, and orthopedics in 4 states (Illinois, New Hampshire, Virginia, and Washington) were observed for 430 hours; 21 physicians also completed after-hours diaries. Findings included:

  • Physicians spent 27.0% of their total time during an office day on direct clinical face-to-face care with patients compared with 49.2% on EHR and desk work.
  • Physicians spent 52.9% of the time in the examination room on direct clinical face time and 37.0% on EHR and desk work.
  • 21 physicians who completed after-hours diaries reported 1 to 2 hours of additional work each night, devoted mostly to EHR tasks.


Sinsky C, Colligan L, Li L, et al. Allocation of physician time in ambulatory practice: A time and motion study in 4 specialties. Ann Intern Med. 2016;165:753-760. doi:10.7326/M16-0961.


This study builds upon the results of similar studies that reinforce and validate what many physicians have been discussing amongst themselves for the last 10 years: that the goals of EHRs have not been met, that they detract from patient care, and that they add a substantial burden to the lives of physicians without clearly giving something back in return. The burden imposed by electronic documentation as well as the added burdens that have been required by governing bodies (meaningful use) and insurance companies (performance measures) have created a great deal of dissatisfaction, with over 50% of physicians reporting that they feel “burned out.”1 It is not clear how much patients have experienced the change brought about by EHRs, but that would be an important next step into our inquiry about the effects of EHRs on the provision of healthcare, and ultimately their effect on the care of patients. —Neil Skolnik, MD

  1. Shanafelt TD, Hasan O, Dyrbye LN, et al. Changes in burnout and satisfaction with work-life balance in physicians and the general US working population between 2011 and 2014. Mayo Clin Proc. 2015;90(12):1600-13. doi:10.1016/j.mayocp.2015.08.023.