Internal medicine interns spend only 13% of workday on direct patient care

A study found that an average of 66% of interns' days were spent on indirect patient care (mostly charting and documentation), showing that “internal medicine is now indeed a trade practiced before a computer screen,” an editorial said.


First-year internal medicine residents spend an average of two-thirds of their workday on indirect patient care, often while multitasking, and only 13% directly caring for patients, a recent study found.

Researchers conducted a direct observational secondary analysis of the individualized Comparative Effectiveness of Models Optimizing Patient Safety and Resident Education (iCOMPARE) trial, which used a cluster-randomized design to compare different duty-hour policies and is supported by grants from the National Heart, Lung, and Blood Institute and from the Accreditation Council for Graduate Medical Education. From March 10 to May 31, 2016, observers collected time-motion data from a total of 194 weekday shifts at six U.S. internal medicine programs. Results were published online on April 15 by JAMA Internal Medicine.

A total of 80 interns (55% men; mean age, 28.7 years) were observed for 2,173 hours. Overall, an average of 15.9 hours of a 24-hour period (66%) was spent on indirect patient care, which was mostly composed of interactions with the patient's medical record or documentation (mean, 10.3 hours [43%]). An average of 3.0 hours (13%) was spent directly caring for patients and an average of 1.8 hours (8%) was spent on education. These patterns were consistent across morning, afternoon, evening, and night.

Interns were frequent multitaskers, the study found. Direct patient care and education often occurred when interns were also performing indirect patient care. On average, multitasking with two or more indirect patient care activities occurred for 3.8 hours (16%) of the workday.

The study was limited to internal medicine interns, and the activities of interns in other specialties are likely to be different, the study authors noted. Other limitations include a potential lack of generalizability to other training programs and the fact that interns were observed only during general medical inpatient rotations.

If one believes that the best way to care for patients and learn from them is personal contact, then one might conclude that the findings are a problem, the authors noted. “A more agnostic view is that even if face-to-face engagement is essential, more may not be necessary given that so much of patient care now occurs in teams, is informed by diagnostic test reports, and is mediated through the work of others,” they wrote.

As recently as the 1990s, interns spent about 25% of their workday face-to-face with patients, an accompanying editorial noted. While the finding that modern interns spend more time with computers than direct patient care is not novel, “The present time-motion study shows that, like it or not, internal medicine is now indeed a trade practiced before a computer screen,” the editorialists wrote.