Between-visit workload in primary care

Abstract

Background: The time spent and complexity of work done by primary internal medicine physicians between office visits has not been well studied.

Objective: To measure the time and complexity of this care.

Design: Cross-sectional study.

Setting: General internists practicing on primary care teams with electronic medical records at a tertiary Veterans Health Administration Medical Center.

Participants: Ten physicians.

Main measures: The project was designed to measure physician work between office visits. The electronic record was used to record the number and complexity of work events by physicians for 1 month. Complexity of work was measured on five levels ranging from Level I with no change in management, Level II with change in management of one disease, Level III of two diseases, Level IV of three diseases, and Level V of four or more diseases. Time sampling was done over 5 days to determine the time spent by level of complexity. Total time per physician was calculated by multiplying the number of events each physician captured by the average time for that physician for that level of complexity.

Key results: Physicians worked a median of 7.9 h per week between office visits. Work was apportioned among Level I (18.3%), Level II (38.3%), Level III (36.5%), Level IV (4.6%), and Level V (2.3%).

Limitations: Single VA population and self-reported data. Findings may not be generalizable to other practice settings.

Conclusion: Primary internists spent a median of 7.9 h per week in work between office visits with 82% of the time involved in changes in management.