SheMD Journal Club: Primary Care Physician Gender and Electronic Health Record Workload

Here at sheMD, we believe in the importance of practicing Evidence-Based Medicine. We believe the same principles apply to discussing Gender and Medical Education. Therefore, we are bringing you an entire Journal Club series! Our series will focus on foundational and new literature within the gender and medicine space.

Today, we will be discussing the article entitled, “Primary Care Physician Gender and Electronic Health Record Workload”

Why is this article important?

• Literature suggests that women physicians spend more time working in the electronic health record (EHR) than do men. This increased EHR time may contribute to the documented higher rates of burnout among women physicians, and possibly lower pay for women.

• Due to EHRs, work outside of patient-provider interactions has become a large proportion of time spent by primary care physicians (PCPs).
  

Article Summary

What they looked at:

• The research team analyzed 8.1 million hours of active EHR work completed by 14,520 clinicians using Athenahealth software over a five-month period in the first half of 2021.

How they measured things:

• The authors measured total time spent by physicians in Epic, defined as the number of minutes the provider was logged into the system; time spent in the in-basket; time spent in notes; time spent in clinical review; time spent in orders; turnaround time, defined as number of days a provider took to mark a message as done, and the physicians’ number of appointments each month

What were their outcomes:

• Women PCPs spend more time on documentation on a per-patient basis, scheduling an average of 60 visits per week, compared to their male counterparts, who schedule an average of 73 visits per week.

• After adjusting for panel size and appointment volume, women PCPs spend 20% more time (1.9 h/month) in the EHR in basket and 22% more time (3.7 h/month) on notes than do their male colleagues (p values 0.02 and 0.04, respectively).

• Women PCPs receive 24% more staff messages (9.6 messages/month), and 26% more patient messages (51.5 messages/month).

• The differences in EHR time are not explained by the percentage of patients in a PCP’s panel.

Why do we care about this article?

What does this mean?

• The authors came up with three possible explanations for increased female in basket time

  • A higher workload for female PCPs in which staff and patients of all genders contact women physicians more frequently

  • Women PCPs spend more time because they are less efficient

  • A higher workload for women PCPs because their patient panels are disproportionately female, and female patients require more time.

How does this apply to us?

• Spending MORE time answering in box questions and documenting in the EHR may lead to a decreased number of patients seen each day. This may contribute to the gender pay gap seen in medicine, as well as increased burnout seen in women physicians.

Take Home Point

• Women PCP’s spend more time working on their EHR inbox. This is due to increased messages from staff and patients compared to their men physician collegues.

Similar Articles

• For further reading on the topic, check out these articles!

  • Differences in Ambulatory EHR Use Patterns for Male vs. Female Physicians.

    • https://catalyst.nejm.org/doi/full/10.1056/CAT.19.0690

  • Sex-Based Differences Entangling with Electronic Health Record Documentation

    • https://pubmed.ncbi.nlm.nih.gov/33284316/

  • The Work Lives of Women Physicians Results from the Physician Work Life Study

    • https://pubmed.ncbi.nlm.nih.gov/10886471/

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