What keeps family doctors busy? A description of medical work beyond patient encounters

Abstract

Objectives: Measuring the amount of time family physicians (FP) spend on direct patient encounters and other medical tasks, determining the number of direct patient encounters and indirect contacts, and describing the range of medical tasks performed. Design: Observational study. Setting: Family practices in the Unidade Local de Saúde de Matosinhos (ULSM), Portugal. Population: Family physicians working in ULSM Methods: A convenience sample of 46 family physicians was invited to record their activities during 2 to 5 working days, in June and July, 2010. They measured the time spent in practice, on breaks and on medical tasks aside from direct patient encounters, the numbers of direct and indirect patient contacts, and the types of medical tasks performed. The characteristics of the study participants and the characteristics of their tasks were analyzed using descriptive statistics. Results: Of the 46 family physicians invited, thirteen participated in the study (28% response rate). The activities of 52 working days were recorded, including 986 direct patient encounters, 514 indirect patient contacts and 100 hours of activities. Of the total daily working time, 23% was spent on non-contact medical tasks (on average one hour and 57 minutes per day), with an average of 10 indirect patient contacts per doctor per day. A mean of six hours and 31 minutes were spent on 19 direct patient contacts per doctor per day. The indirect contact tasks most often reported were: telephone calls, e-mails, medical record keeping, evaluation of laboratory and other tests, prescription refills, completing forms, interactions with other members of the team, referrals and staff meetings. Conclusions: This sample of family physicians spends an average of one hour and 57 minutes per day on non-contact patient related tasks, accounting for 23% of their workload. This is similar to the findings from North American studies. There are several likely biases in this study related to sample selection and data collection. This study illustrates the range of tasks that family physicians perform, as well as the amount of time required to perform them. This may contribute to improve the recognition of the workload created by these tasks as well as indicating their importance, with potential effects on professional satisfaction.