Primary Care Physician Gender and Electronic Health Record Workload

Abstract

Background: Prior research indicates that female physicians spend more time working in the electronic health record (EHR) than do male physicians.

Objective: To examine gender differences in EHR usage among primary care physicians and identify potential causes for those differences.

Design: Retrospective study of EHR usage by primary care physicians (PCPs) in an academic hospital system.

Participants: One hundred twenty-five primary care physicians INTERVENTIONS: N/A MAIN MEASURES: EHR usage including time spent working and volume of staff messages and patient messages.

Key results: After adjusting for panel size and appointment volume, female PCPs spend 20% more time (1.9 h/month) in the EHR inbasket and 22% more time (3.7 h/month) on notes than do their male colleagues (p values 0.02 and 0.04, respectively). Female PCPs receive 24% more staff messages (9.6 messages/month), and 26% more patient messages (51.5 messages/month) (p values 0.03 and 0.004, respectively). The differences in EHR time are not explained by the percentage of female patients in a PCP's panel.

Conclusions: Female physicians spend more time working in their EHR inbaskets because both staff and patients make more requests of female PCPs. These differential EHR burdens may contribute to higher burnout rates in female PCPs.

Keywords: Burnout; Electronic health record; Gender.

Figure 1.

Fraction of patient panel that is female by physician gender.

Figure 2.

Time spent in inbasket by physician gender and the percentage of female patients in the panel. Note: Figure shows one data point per physician where the monthly observations have been collapsed to the physician level by taking the mean of the monthly observations. The regression lines are estimated on the collapsed data. The comparable slopes and p-values for a regression of inbasket time on panel percent female using the individual monthly observations are 3.5 (95% CI −15.2 to 22.2, p-value=.72) for male MDs and −12.4 (95% CI −21.5 to −3.3, p-value =0.01) for female MDs.

Figure 3.

Time spent in notes per month by patient gender. Note: Figure shows one data point per physician where the monthly observations have been collapsed to the physician level by taking the mean of the monthly observations. The regression lines are estimated on the collapsed data. The comparable slopes and p-values for a linear regression of monthly notes hours on panel percent female using the individual monthly observations are −3.4 (95% CI −37.6 to 30.8, p-value=.85) for male MDs and −32.6 (95% CI −57.9 to −7.3, p-value =0.01) for female MDs.