Does it matter how much time interns spend with patients?

Many medical interns spend more time on their computers than actually providing care to patients. That’s no surprise to those in the medical field who have seen the impact of clunky electronic medical records (EMRs) and administrative burden on clinicians’ workload. However, a recent study in JAMA Internal Medicine by Dr. Krisda Chaiyachati at the University of Pennsylvania and colleagues, shows the potential effects that limited direct patient care from interns may have on the health care industry.

This study followed 80 internal medicine interns in six US medical resident programs, for a cumulative 2173 hours, making this analysis the largest time-motion study in the US to date. The authors found that interns spent 3 hours (13%) of their day working directly with patients and 2 hours (7%) on educational activities. This is a stark change compared to the 1990s, in which interns spent 81% of their workdays engaged in direct patient care activities. Additionally, the time-motion study highlights how much interns today are multitasking; even when they are face-to-face with patients or at a lecture, they are also working in the EMR 25% of the time.

In an accompanying commentary in JAMA Internal Medicine, Dr. Christopher Moriates, MD and Dr. F. Parker Hudson from the Dell Medical School at The University of Texas at Austin relate this study to larger concerns about internal medicine. This study confirms that over time, technology seems to have increased interns’ administrative burden, not relieved it. The study also finds that the same pattern of more time spent on indirect than direct patient care is consistent across types of care settings, from major academic programs to community-based programs. No EMR system appears to be providing relief from the mounting burden of patient documentation. 

Moriates and Hudson address the question of whether spending time on electronic medical records (EMR’s) is directly related to the ever-worsening problem of physician burnout. They draw from their own teaching experiences, recalling interns who went into medicine to care for patients, not document their care, being discouraged by the lack of time they had with patients. They fear that the pattern of growing EMR burden for interns could be “leading to a deficit in the humanistic bonds that create exceptional care and replenish our psyche.” How will internal medicine retain doctors when their first taste of medicine is so cold and metallic? 

If we indeed value the human side of medicine, this study should serve as a “clarion call to reinvest in the humanistic aspects of medical training,” write Moriates and Hudson. This could mean hiring scribes to do more patient documentation, restructuring EMRs to make them more intuitive and clinician-friendly, or streamlining EMR messages to reduce alert and message fatigue. If we do nothing to solve this problem, we will likely see an even more detrimental impact on clinician burnout and doctor-patient relationships.