Case study

Physician time in ambulatory care

Showcasing how WOMBAT is used by global research teams

Following the results of a large survey, which revealed signs of burnout and growing dissatisfaction with work-life balance amongst US physicians, the American Medical Association were interested in quantifying how physicians in ambulatory care spend their time.

In collaboration with the Dartmouth-Hitchcock Medical Center and the Centre for Health Systems and Safety Research, Macquarie University, the researchers undertook a WOMBAT study of 57 physicians working in four specialties (family medicine, internal medicine, cardiology and orthopaedics) across four states (Illinois, New Hampshire, Virginia and Washington).

A physician work task study template for ambulatory care was devised, which included 12 broad work task categories grouped under four key activities:

• direct clinical face time
• electronic health record (EHR) and desk work
• administrative tasks;
• other tasks.

Ten medical students were trained regarding the study template classification definitions and how to use WOMBAT. The students undertook 430 hours of observation of ambulatory physicians’ work.

Findings

The findings showed that during office hours, ambulatory care physicians spent:

• nearly half their time on EHR and desk work activities
• less than one third on direct clinical face time with patients.

In other words, for every hour of direct clinical face time with patients, physicians spent almost two hours on EHR and desk work.

Such findings provide critical information in characterising the ambulatory care domain regarding what work is done and for how long.

Using WOMBAT allowed the researchers to describe ambulatory physicians’ time distribution objectively, capturing work and interactions both with and without electronic devices, and provided a broader view of the role and use of the EHR in the ambulatory environment.