Me: “Want three more weeks off each year?”
You: “Of course, I do! What do I have to do to get it?”
You might think you will have to negotiate your contract. Or you might need to beg.
Nope, it is easy. You just chart like a guy!
In the February 2021 JAMA Internal Medicine article “Electronic Health Record Use by Sex Among Physicians in an Academic Health Care System,” the authors looked at how much time it took for an attending physician to chart for their outpatient visits. They looked at both surgical and medical specialties and analyzed data based on the gender of the physician. The most astonishing thing that they found was that women charted on average about 33.4 more minutes in the EHR per day. Startlingly, that adds up to greater than three 40-hour work weeks per year more than men.
There are many gender differences in medicine. We already know patients have increased expectations of the time women physicians spend with them and that women physicians do more service, i.e., non-paid duties. And most well-touted, women are compensated less than male physicians, so we basically work for free three months out of the year.
Now, on top of that, we lose three weeks of much-needed free time to EMR charting!
In this study, they reported statistically significant differences where women were doing more charting from the hours of 7:00 PM to 7:00 AM (AKA pajama time), outside of scheduled hours, and on days they were not scheduled for the clinic.
You would think that because of this dedication to charting, women attending physicians are closing more notes on the same day of the visit or are getting better marks on other metrics than their male colleagues.
You would think that this would translate into better patient satisfaction scores.
Nope and Nope.
There were no differences in these measures based on gender. No benefit and more time spent. It sounds like a lose-lose situation for women physicians.
What can we do to fix this?
This is a perfect time to address this because there are new charting requirements for outpatient medical visits. As of January 2021, Office Evaluation and Management (E/M) CPT Code requirements were revised to reduce documentation burden and to recognize the importance of non-face-to-face activities involved in taking care of the patient. In addition to traditional medical-decision-making documentation coding, this new time-based coding compensates for time spent reviewing tests before the appointment, obtaining or reviewing separately obtained history, and ordering and interpreting medications, tests, or procedures that occur on the same day of the visit. Physicians should start adjusting their documentation to take advantage of this opportunity to lighten their notes when appropriate. We should create new routines and habits!
A second way to decrease time spent documenting in the EMR is to assess the note’s purpose. What is the minimum necessary documentation needed to help us and our colleagues know what is required for the patient’s care and to meet compliance with insurance requirements? As an internist, I have indeed written my share of very lengthy and detailed notes over the years, but I am ready to make a change!
We also need to spend time setting up ways to be more efficient in our charting with templates and smart phrases. If you have said it more than once in a note, find a way to set up a shortcut so that the next time you need to document the same thing in a different situation, you have a more efficient way to do so. Taking the time now will save you more time in the future.
Lastly, I have learned from several charting coaches that it is crucial to establish boundaries to decrease distractions during your clinic time to finish charting at the time of the visit. In following this practice, you do not have to struggle to remember details later, and you will be more concise.
There is a little work required to set yourself up for future success, but it will be worth it. Start by blocking off some time to update your templates, smart phrases, dictation prompts, and coding plans. Then shift your mindset to take back control of your time from the EMR shackles.
Finish up by dreaming a little: Imagine what else you could be doing during those 120+ hours.
Marion Mull McCrary MD FACP is a practicing primary care general internist in North Carolina. She works with both physicians and non-physicians as a certified integrative health and wellness coach. She is also a Women in White Coats Fellow. Her website is http://www.marion-wellness.com, and she can be followed on Instagram and Facebook at marionmccrarywellness.