Regardless of training year or specialty, resident physicians spend considerably more time away from the patient bedside than they do in face-to-face interactions.
According to recently published 2023 national comparison report based on survey responses from more than 2,000 resident physicians across 22 organizations using the AMA Organizational Biopsy®, residents reported spending about 26 hours a week—or 40% of their time—on direct patient-care activities.
That compares with 28 hours a week on indirect and administrative tasks associated with care delivery. The remaining 20% of their time was spent on research and other parts of the residency experience.
Direct patient-care activities included face-to-face time with a patient, such as obtaining history, conducting an exam and crafting care plans. Indirect patient-care activities involved elements such as documentation, order entry, test interpretation, referrals, and communication with the care team. Administrative tasks, meanwhile, included dealing with prior authorization, insurance forms, paperwork and meetings.
How trainees spend time
When compared with prior-year data, the overall time spent working each week rose by about four hours—to 63.6 hours. That figure also varies by a number of demographic factors, including specialty, program year and gender. The overall burnout rate reported by the 2023 survey respondents was 42.5%, up slightly from the 41% rate in 2022.
Survey respondents included residents ranging from interns through PGY-5 and fellowship. Second-year residents reported the highest number of hours worked, at 67 per week. Their direct-patient care hours were logged at 25.4 hours per week, compared with 30.1 weekly hours for indirect and administrative tasks. Their associated rate of reported burnout was 46.3%.
Internal medicine residents reported the fewest weekly hours of direct patient care—23.1—and the highest reported weekly hours on indirect and administrative tasks associated with care delivery, at 33.9. Reported burnout among internal medicine residents was 43%.
Why bedside time matters
Brian Garibaldi, MD is a professor of medicine at Johns Hopkins University School of Medicine. He also is one of the primary investigators on a project funded by the AMA Reimagining Residency initiative for which he has done extensive research on how residents spend their time.
Dr. Garibaldi posited that residents may be unintentionally overreporting the amount of time they spend on direct patient-care activities because it is the element of their training they find the most rewarding. By contrast, data from Dr. Garibaldi’s research using infrared real-time location systemtracking badges indicated that interns spent as little as 13% of their time in direct patient care.
“You're more likely to report spending time doing the things that you think are valuable and important as part of your job,” Dr. Garibaldi noted.
Spending more time on nonpatient-care activities can have an impact on resident physicians’ well-being. There are significant correlations between “reporting that you spend more time with patients and having higher wellness, higher resiliency and the lower burnout,” Dr. Garibaldi said.
“We all think that spending time with patients is valuable and important,” he added. “We didn't go into medicine to sit in front of a computer and take care of a digital representation of the patient. We wanted to help real people navigate ... their illness journey, even if we're not able to fix their underlying disease.”
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Too much hallway time
Systemic interventions in areas such as team-based care are needed to reduce administrative burdens and create more time at the bedside in residency. While those are essential, another change that is relatively simple could have a profound effect—conducting ward rounds in the patient’s room.
“There's a lot of missed opportunities if you're not spending time with patients and trainees at the bedside,” Dr. Garibaldi said. “If you want to teach people how to be good physicians, they have to see experienced clinicians modeling the types of behaviors that we think are valuable at the bedside. For example, how to how to talk to a distressed family member, how to share bad news, how to conduct a physical exam on a patient who is unresponsive and sedated on the ventilator.”
In ensuring rounds are patient-centered, Dr. Garibaldi advocated avoiding extensive hallway discussions.
“A lot of rounding happens in the hallway, away from patients,” he said. “Residents and physicians are drawing diagnostic schemas or talking about the latest paper related to the disease the patient may or may not have. We need to buy back some of that time and actually spend it with patients, talking with them, verifying important information, examining them and making sure that we understand what's happening to them from a pathophysiologic standpoint.
“We also need to use that time to directly observe trainees during a clinical encounter and provide them with personalized feedback,” he added. “That doesn’t occur often enough in graduate medical training and can’t happen in the hallway.”
Learn more with the AMA about well-being programming for residents and fellows.
