Transition from Resident to Attending

In 1st physician job, how much of your week will be spent on the EHR?

Researchers examine nearly 200,000 physicians’ EHR logs and develop a new way to compare apples to apples on clerical burdens.

By
Timothy M. Smith , Contributing News Writer
| 6 Min Read

AMA News Wire

In 1st physician job, how much of your week will be spent on the EHR?

Jan 24, 2025

After years of all-consuming training in medical school, residency and sometimes fellowship, when it comes time to begin searching for that first physician job that will mark your transition to full-time practice, how many hours a week you will be obliged to put in is rightly among the considerations that are top of mind. 

One standard way to detail that expectation is the number of patient-scheduled hours in a given week. But the contemporary practice of medicine involves hours on EHR clinical documentation and messaging tasks and the number of patient-scheduled hours vary across organizations depending on policies and support. So, knowing the number of patient-scheduled hours expected does not present a fully transparent picture for physician job-seekers. It can be like comparing apples and oranges.

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Now comes research led by experts at the AMA that introduces a new way to measure the physician workweek and make it more of an apples-to-apples comparison. The aim is to make credible comparisons easier for individual physicians while also giving health care leaders a new way to gauge the clinical burdens their physicians are facing. Even sophisticated health care leaders have lacked reliable data on the sum of direct and indirect patient-care hours, as well as how these times may differ by specialty and by the level of team support at the unit level.

For a cross-sectional study published in the Journal of the American Medical Informatics Association (JAMIA), researchers looked at the number of patient-scheduled hours (PSH) that result in a 40-hour work week for ambulatory-care physicians, as estimated by EHR activity logs. 

Using EHR activity log data from Epic, the researchers calculated this number, abbreviated as PSH40, for more than 186,000 physicians across 395 health care organizations over six months in 2021–2022 and determined how PSH40 varies by physician specialty and practice setting.

The median PSH40 for the sample was 33.2 hours, meaning that the typical weekly number of “work outside of work” hours estimated for each physician was 6.8.

PSH40 was lowest—at 26.2—in infectious disease, says the JAMIA study. That means the infectious disease physicians spent the most time on EHR work outside of work. Next was geriatrics with 27.2, hematology with a PSH40 and 28.6. PSH40 was highest—at 36, and meaning the lowest work outside of work—in sports medicine, then 35.8 in pain medicine and 35.7 in plastic surgery. The formula used to calculate PSH40 is described in detail in the study, published last fall and available at no charge.

The authors’ motivation was to use this new metric to jumpstart conversations about what is a reasonable work week and what level of support creates greater capacity to spend more time face to face with patients.

“Let's bring this to the light of day and then let's use science to figure out how we can create a better work environment for physicians and a better care environment for patients,” said Christine A. Sinsky, MD, the JAMIA study’s lead author and vice president of professional satisfaction at the AMA. 

“If you can decrease the administrative and clerical work required of physicians, you can increase their PSH40 and thus increase access for patients and revenue for the organization. This can be achieved by deploying more support staff, creating a more reasonable compliance environment, reducing the number of unnecessary policy restrictions such as mandated physician-order entry, and by implementing technology that takes less time rather than more,” said Dr. Sinsky. She who co-wrote the study with Lisa Rotenstein, MD, MSc, A. Jay Holmgren, PhD, MHI, and Nate C Apathy, PhD.

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The authors arrived at each specialty’s PSH40 number by first calculating the average weekly number of work-outside-of-work hours for each physician in that specialty. They did this by summing active EHR time outside of clinical hours on scheduled days, along with active EHR time on unscheduled days. 

They then normalized this total to one hour of patient-scheduled time by dividing that total by the total weekly number of patient-scheduled hours. This value captures the additional time spent on the EHR for every hour of scheduled patient time. 

There are some important limitations to the available EHR activity-log data that likely underestimate time spent on work outside of patient scheduled hours and thus overestimate PSH40, Dr. Sinsky noted. For example, much of it depends on how Epic logs data. She cautioned that physicians and health care leaders should not take figures literally and think that, for example, 32 hours of patient contact will mean only 40 hours of work a week. That is because the way time is measured by EHR vendors likely underestimates the actual time spent on EHR activities. 

For example, Epic’s Signal doesn’t count EHR work that happens in the 30 minutes before or after a clinic session as work outside of work, so it could miss as much as an hour of after-hours work each day. In addition, the Signal platform stops counting active time after five seconds of mouse or keyboard inactivity. Finally, some of the additional work physicians do, such as talking on the phone with patients or colleagues, is not captured in the EHR activity logs. If one were to include those factors, a primary care physician’s PSH40 might be much lower, perhaps in the range of 26–28 hours.

From AI implementation to EHR adoption and usability, the AMA is fighting to make technology work for physicians, ensuring that it is an asset to doctors—not a burden.

One group of people who could benefit from this new metric are those most affected by what it shows—individual physicians who are transitioning to practice or midcareer physicians looking for greener pastures.

“The individual physician could use it,” Dr. Sinsky said in an interview. “It can help with their decision about where they should work, especially if they feel their work has encroached on their family life.”

The metric also can be used by health care leaders, she said.

“You can look at it and say: Wow, the work outside of scheduled hours is much greater for some physicians than others,” she noted. “So what do we need to do to help our infectious disease physicians, geriatricians and primary care physicians offload some of that indirect work? And if we do something, what will that do to our ability to offer additional appointments in these specialties?”

Then there are policymakers. Research by Dr. Sinsky and others has demonstrated the burdens of physician performance measures run amok, as published in JAMA Internal Medicine and Annals of Family Medicine. Tracking PSH40 could be one way of demonstrating the impact of such policy choices and shaping the search for smarter ways to improve care while also supporting physicians’ well-being.

The AMA has assembled a variety of resources to help physicians flourish in the employment setting. They include the AMA STEPS Forward® toolkit, “What to Look for in Your First or Next Practice,” the AMA Physicians’ Guide to Hospital Employment Contracts (PDF), free for AMA members, and the Annotated Model Physician-Group Practice Employment Agreement (PDF).

Learn more with the AMA about understanding physician employment contracts.

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