How Many Hours Do We Work Anyway: Quantifying Work Effort Among Primary Care Providers Nationwide

Presentation Type: Oral Presentation - Regular
Presentation Time: 10:15 AM - 10:27 AM

Abstract Keywords: Clinician Well-Being, Health Policy, Reimbursement and Affordability, and Sustainability, Workforce Automation, Communication, and Workflow Efficiency
Primary Track: Advancing Wellness for Providers and Community with Consideration of Human Factors


Introduction: Primary care work extends beyond face-to-face visits, yet the total time required to deliver care - and how this varies by clinician full-time equivalency (FTE) - is poorly quantified at a national level. Accurate estimates are essential to help design sustainable workload and fair reimbursement models.

Methods: We conducted a retrospective observational study using Epic Signal electronic health record (EHR) activity log data for primary care physicians (PCPs) across the U.S. from October 2021 to April 2022. We calculated weekly work effort using two approaches: (1) billed visit volume ("billing-based" effort), and (2) EHR-based appointment logs ("scheduled-based" effort). Both measures were normalized to 1.0 clinical FTE, with full-time defined as 36 hours per week.

Results: Among 46,109 PCP across 370 organizations, median weekly effort scaled to 1.0 FTE was 67.2 hours per week using the billing-based method and 70.5 hours per week using the scheduled-based method. Effort varied substantially by FTE, ranging from 95.8 hours per week for PCPs with FTE <0.25, to 58.0 hours per week for those with FTE ≥0.75. Effort increased with patient age and clinical complexity and was higher for clinicians in smaller organizations, largely driven by higher visit volume.

Conclusion: PCPs spend more than 60 hours per week delivering synchronous and asynchronous care. Effort varies meaningfully by FTE, patient complexity, and organizational context, underscoring the need to incorporate comprehensive effort measures into workload expectations, staffing, and reimbursement models.

Speaker(s):
Isabel Ostrer, MD
University of California San Francisco

Author(s):
Lisa Rotenstein, MD, MBA, MSc - UCSF;

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Clinical Documentation Burden: Differences Across Payment Environments

Presentation Type: Oral Presentation - Regular
Presentation Time: 10:27 AM - 10:39 AM

Abstract Keywords: Health Policy, Reimbursement and Affordability, and Sustainability, Clinician Well-Being, Human Factors and Usability
Primary Track: Advancing Wellness for Providers and Community with Consideration of Human Factors


Physicians frequently lament extensive electronic health record (EHR)-based documentation requirements for billing and payment. We conducted a parallel mixed-methods study using Epic EHR metadata and semi-structured interviews with physicians and EHR vendors to compare documentation across different payment environments. No environment outperformed on quantitative measures or in qualitative reflection. Respondents highlighted difficulties practicing across multiple payment environments, frequently creating “blended” note templates for the “highest common denominator” requirements, challenging intervention by any one payer.

Speaker(s):
Nate Apathy, PhD
University of Maryland

Author(s):
Nate Apathy, PhD - University of Maryland; Genna Cohen, PhD - N/A; Sarah Rosenthal, BA - Harvard University; A J Holmgren, PhD - University of California, San Francisco;

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A 5-year Evolution of the Ambulatory Clinic Note

Presentation Type: Oral Presentation - Regular
Presentation Time: 10:39 AM - 10:51 AM

Abstract Keywords: Education and Training, Change Management, Leadership and Strategy, Generative AI in Clinical Workflow: Ambient Listening, Chart Summarization, Automated Response with LLM, Telemedicine, Health at Home, and Virtual Care
Primary Track: Driving Change at Scale through Effective Leadership and Governance


For the past 7 years, we have employed two full-time multidisciplinary EHR Optimization and Training Sprint teams that spend 60 weeks per year partnering with front-line primary care and specialty clinicians to standardize workflows and create efficiency and value for clinicians and patients. Through these efforts, we have achieved 55% usage of a standard ambulatory note, and 40% usage of our custom problem-based charting tool. Through direct observation, we have discovered common knowledge gaps that we would like to share with other organizations who are trying to cut through the rapidly changing health care delivery models and innovative EHR tools to create compliant and billable notes.

Speaker(s):
Amber Sieja, MD
UCHealth

Author(s):
Amber Sieja, MD - UCHealth; Daniel Goodeill, DO - UCHealth, University of Colorado Medical Group;

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Navigating the Triple Burden in Primary Care: Addressing Information Tracking, Prior Authorization, and Pajama Time

Presentation Type: Oral Presentation - Regular
Presentation Time: 10:51 AM - 11:03 AM

Abstract Keywords: Human Factors and Usability, Change Management, Workforce Automation, Communication, and Workflow Efficiency
Primary Track: Implementing Real-World Change, Digital Engagement, and Connected Health


Family physicians face a triple administrative burden: tracking external information, managing PA, and completing documentation after hours. Using 2024 ABFM data from 8,419 physicians, we quantify the prevalence and co-occurrence of these burdens and assess how EHR capabilities, staffing models, and documentation supports relate to them. Findings show widespread strain, limited relief from current PA tools, and notable benefits from interoperability and documentation supports. Results point to targeted workflow and policy strategies to reduce burden.

Speaker(s):
Meghan Hufstader Gabriel, PhD
Office of the Assistant Secretary for Technology Policy

Author(s):
Jordan Everson, PhD - Georgetown University School of Medicine; Chelsea Richwine, PhD - Office of the Assistant Secretary for Technology Policy; Andrew Bazemore; Robert Phillips, MD MSPH;

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Human-AI Relational Dynamics in Clinical Documentation and Safety

Presentation Type: Oral Presentation - Student
Presentation Time: 11:03 AM - 11:15 AM

Abstract Keywords: Change Management, Human Factors and Usability, Generative AI in Clinical Workflow: Ambient Listening, Chart Summarization, Automated Response with LLM, Education and Training, Leadership and Strategy
Primary Track: Advancing Wellness for Providers and Community with Consideration of Human Factors


Why do some people resist AI-related change even when it is easier and more accurate than ever before? This session introduces the interdisciplinary Human-AI Relational Dynamics framework, which explains clinicians’ emotional and interpretive responses to AI. Using mixed methods, we analyze how contextual cues in AI-generated discharge summaries can shift empathy, diagnostic attention, and perceived harmfulness. Understanding these dynamics is essential for reaching populations beyond early adopters and strengthening change-management strategies in AI-assisted clinical workflows.

Speaker(s):
Jasmine Kim, M.D.
Boston Children's Hospital

Author(s):
Jasmine Kim, M.D. - Boston Children's Hospital; Jonathan Hron, MD - Boston Children's Hospital; Chase Parsons, DO, MBI - Boston Children's Hospital;

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Smart Attestation: A Targeted Approach to Reducing Documentation Time

Presentation Type: Oral Presentation - Student
Presentation Time: 11:15 AM - 11:27 AM

Abstract Keywords: Clinician Well-Being, Health Data Science, Clinical Decision Support and Care Pathways
Primary Track: Advancing Wellness for Providers and Community with Consideration of Human Factors


Provider attestation requirements are complex. We implemented a context-aware "Smart Attestation" framework using Clinical Event Rule logic to automate the display of compliant attestation options. Post-implementation analysis revealed a reduction in mean documentation time from 133 to 113 seconds per note. These results demonstrate that targeted, logic-driven decision support reduces cognitive load and improves documentation efficiency across diverse clinical scenarios.

Speaker(s):
Oluwatoba Moninuola, MD MPH
The Ohio State University

Author(s):
Lynda Villagomez, MD - Nationwide Children's Hospital; Emily Sentman, MD - Nationwide Children's Hospital; Aarti Chandawarkar, MD, FAAP, FAMIA - Nationwide Children's Hospital; Jennifer Lee, MD - Nationwide Children's Hospital;

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