What does an intern doctor actually do? A quantification of time on work activities

Background

Interns, or first year junior doctors, have traditionally been used as an adaptable frontline solution to many of the changes in healthcare, utilising their broad skill sets for both direct patient care and administrative burdens. While there are studies that focus on the total hours junior doctors work, there are few that analyse the specific tasks they do and how they dedicate their work time.

Aims

We aim to quantify the amount of time intern doctors spent on specific tasks during a shift.

Methods

This is a multi-centred, retrospective, self-reported study that was carried out in a public tertiary hospital network in Western Australia, comprising one tertiary, two metropolitan, and three regional hospitals. 68 individual shifts were reported, accounting for 605.72 hours. Participants reported time spent, in fifteen minute segments, on categories grossly defined as clerical tasks, clinical tasks, teaching, and personal time. Participants were also asked about their satisfaction with the amount of clinical exposure during the reported shift.

Results

Direct patient care accounted for 22 per cent of total shift time, indirect care 74 per cent, and personal time 4 per cent. Discharge summaries accounted for the most time-per-shift at 26 per cent, followed by medical note documentation at 14 per cent, with the least being teaching at 2 per cent. Direct patient contact by interns during a shift was on average 12 per cent (SD 14 per cent). 12 interns or 18 per cent of all responses reported no direct patient contact (0 per cent) during a shift. Interns working in emergency medicine spent 44 per cent of their shift on direct patient contact, significantly more compared to their medicine and surgical colleagues.

Conclusion

Indirect care activities consume almost three times as much time as direct care activities. Interns are mostly unsatisfied with their amount of clinical exposure per shift. The results concur with the current literature of increasing levels of clerical and administrative burden, and decreasing relevant clinical exposure in doctors' work.