Seven Habits for Reducing Work After Clinic

 

Imagine shutting your office door at the end of the day and not having any work that you need to take home. These shifts in practice can help you reclaim your time.

Fam Pract Manag. 2019 May-June;26(3):10-16.

Author disclosures: no relevant financial affiliations disclosed.

The administrative burden on family physicians is immense. Prior authorizations, quality reporting, formularies, refills, sign-offs, messages, documentation guidelines, and electronic health records (EHRs) can all frustrate physicians' efforts to focus on providing high-quality patient care. These administrative hassles undoubtedly contribute to the rise in “work after clinic” as well as physician dissatisfaction and burnout.

A recent study of four specialties, including family medicine, found that physicians in ambulatory practice spend one to two hours each night on EHR tasks or paperwork – not to mention all the time they spend on these tasks during the workday.1 A separate study found that family physicians spend nearly 30 hours per month working on the EHR after hours, with activity peaking on weekends around 10 a.m. and again at 10 p.m.2 This has been dubbed “date night with the EHR.”3

But perhaps it doesn't have to be this way.

Changes are needed at the organizational and national levels to fix our broken system (see “What's being done to address administrative complexity?”). But in the meantime, physicians have to find ways to regain some control over their time and not burn out.

This article will share practical steps physicians can take to improve efficiency and reduce the amount of time they spend working after hours. These strategies are based on our collective experience and offer a variety of approaches to the problem depending on your personal work style, your practice workflow, your priorities, etc. It is our hope that, by focusing on what physicians can control and applying sound principles to our work, we can reduce the burden and restore the joy of practicing medicine.

KEY POINTS

  • While changes are needed throughout the health care system to reduce administrative complexity, physicians must find ways to regain some control over their time and not burn out.

  • Time management tactics, improved delegation, message management, and more efficient documentation practices can help reduce the amount of time physicians spend working after hours.

  • When addressing the problem of work after clinic, practices should be careful not to apply more pressure on already pressured physicians; a better approach involves empathy, mentoring, and accountability.

WHAT'S BEING DONE TO ADDRESS ADMINISTRATIVE COMPLEXITY?

Reducing the administrative burden on family physicians is a strategic objective of the AAFP. It has combined advocacy efforts with five other specialty societies, representing more than 560,000 physician and medical student members, and drafted the Joint Principles on Reducing Administrative Burden. The issues the AAFP is addressing include advocating for less onerous documentation and billing guidelines, interoperability of EHRs to support care across the continuum, a core set of primary care quality measures that would be used by all payers, reduced prior authorization demands, and other issues.

As part of its Patients Over P

ABOUT THE AUTHORS

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Dr. Reddy is a family physician in a small independent group family practice in Salinas, Calif....

Dr. Rippey practices family medicine and sports medicine in a hospital-owned clinic in Bluffton, S.C.

Dr. Cuenca practices family medicine and sports medicine in a large multispecialty group in Mission Viejo, Calif.

Dr. Sexton is a family physician in an independent, multispecialty group in Arlington, Va., an associate professor at Georgetown University School of Medicine, and editor-in-chief of American Family Physician.

Dr. Fiesinger is a family physician in a large primary care group in Houston.

Dr. Adler is a family physician in a physician-owned, predominantly primary care medical group practice in Tucson, Ariz., and is the former medical editor of FPM.

Drs. Reddy, Rippey, Cuenca, Sexton, and Fiesinger are all members of FPM's Editorial Advisory Board.

Brandi White is senior editor and web content manager for FPM.

Author disclosures: no relevant financial affiliations disclosed.

References

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1. Sinsky C, Colligan L, Li L, et al. Allocation of physician time in ambulatory practice: a time and motion study in four specialties. Ann Intern Med. 2016;165(11):753–760....

2. Arndt BG, Beasley JW, Watkinson MD, et al. Tethered to the EHR: primary care physician workload assessment using EHR event log data and time-motion observations. Ann Fam Med. 2017;15(5):419–426.

3. Sinsky CA. Infographic: date night with the EHR. NEJM Catalyst blog. Dec. 12, 2017. https://catalyst.nejm.org/date-night-ehr. Accessed March 21, 2019.

4. Schulte F, Fry E. Death by 1,000 clicks: where electronic health records went wrong. Kaiser Health News and Fortune. March 18, 2019. https://khn.org/news/death-bya-thousand-clicks. Accessed March 21, 2019.

 
 

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