Interns may devote only 12% of their time to patients

In the New York Times (5/30) “Well” blog, Pauline W. Chen, MD, writes that a “dramatic decrease in time spent with patients compared with previous generations appears to be linked to new constraints young doctors now face, most notably duty hour limits and electronic medical record-keeping.”

She cites a recently published study in the Journal of General Internal Medicine showing results that interns now spend almost half their days in front of a computer screen, more than they do with patients. When the study authors “calculated the amount of time spent face to face with patients, the researchers found that interns were devoting about eight minutes each day to each patient, only about 12 percent of their time.”

Researchers from John’s Hopkins and University of Maryland School of Medicine studied whether the Accreditation Council for Graduate Medical Education (ACGME) Common  Program Requirements, that were launched in July of 2003 and revised in 2011, which limit continuous and total work hours for interns and increase supervision requirements impact time spent directly with patients. They assessed whether limiting the length of shifts and total time in the hospital, particularly for interns, will reduce the time spent at the patient’s bedside and alter the balance between service and learning.

Researchers  recorded intern activities at two internal medicine residency programs at large academic medical centers in Baltimore, MD during January, 2012. Using the iPod Touch™ “TimeTracker” application. The application allows observers to track intern time utilization in a variety of activities in real-time, including multitasking (a total of 873 intern hours). Data collection was anonymous.

Results  showed that “interns in this study spent a minority of their time, approximately 12 %, in direct contact with patients. Two-thirds of intern time was spent in indirect patient care, including entering orders, consulting with other physicians, writing notes, and reading the patient chart. Interns spent 40 % of their time in front of computer screens, and more time reviewing patient charts than directly engaging patients.”

Study authors point out that “The goal of residency training is to produce competent
physicians capable of practicing independently. To reach the educational milestones needed to demonstrate independence, residents must hone their skills in patient care and
communication. As the ACGME common program requirements highlight, “For the resident, the essential learning activity is interaction with patients under the guidance and
supervision of faculty members.” Prior studies have found that more time spent with patients may improve patient satisfaction, patient education, and clinical outcomes, and
reduce inappropriate prescribing.

Chen P. NY Times Well Blog, May 30, 2013
Block L, et al. J Gen Intern Med. 2013