How Much Time Do Doctors Spend on Documentation and the EHR?
Time-motion and EHR log studies show how much of a physician's day goes to documentation and the inbox. What the evidence says and where the hours go.
Nabady editorial team··4 min read
Ask any clinician where the day went and the answer is rarely "with patients". Over the past decade, researchers have stopped relying on impressions and started measuring physician time directly, first with observers holding stopwatches and later with the audit logs that every electronic health record (EHR) keeps. The results are consistent and sobering: documentation and related desk work take a share of the working day comparable to, and often larger than, direct patient contact.
Most of the large studies come from the United States, where EHR vendors make usage data available at scale. Comparable published data for the Middle East and Africa remain limited, but the tasks involved (writing notes, entering orders, answering messages) are much the same wherever an EHR is in use.
The landmark time-and-motion study
In 2016, Sinsky and colleagues published a time-and-motion study in the Annals of Internal Medicine that became a reference point for the debate. Trained observers followed 57 physicians in family medicine, internal medicine, cardiology and orthopedics for a total of 430 hours.
- Physicians spent 27.0% of their office time on direct clinical face time with patients.
- They spent 49.2% on EHR and desk work.
- In other words, for every hour of face time, nearly two additional hours went to the EHR and desk work during the clinic day.
- Physicians who also kept after-hours diaries reported one to two hours of extra work each night, mostly in the EHR.
The authors noted an important limitation: the practices were self-selected and considered high-performing, so the results may not generalize everywhere. If anything, less organized settings could fare worse.
What EHR audit logs revealed
A year later, Arndt and colleagues used a different method in the Annals of Family Medicine (2017). They analyzed EHR event logs for 142 family physicians in a health system in Wisconsin and validated the logs against direct observation.
The headline figures:
| Measure | Result (per weekday, per 1.0 clinical FTE) |
|---|---|
| Total EHR time | 355 minutes (5.9 hours) of an 11.4-hour workday |
| EHR time after clinic hours | about 1.4 hours |
| Clerical and administrative tasks (documentation, orders, billing, coding) | 157 minutes, 44.2% of EHR time |
| Inbox management | 85 minutes, 23.7% of EHR time |
The study made one point clear. A large share of EHR time does not involve clinical reasoning. It goes to clerical work and message triage that often spills into evenings, which many clinicians call "pajama time".
Recent national data: still around six hours
Has the situation improved as EHRs matured? A national analysis published in 2024 in the Journal of General Internal Medicine (Holmgren, Sinsky, Rotenstein and Apathy) used de-identified usage data from ambulatory physicians on a major EHR platform across the United States. It found that physicians spent nearly six hours in the EHR for every eight hours of scheduled patient care. Specialties that are mainly non-procedural, such as primary care, logged more EHR time than procedural specialties.
The authors acknowledge that the data come from a single vendor. Even so, the results are consistent with the earlier studies: the documentation burden has not gone away.
Where the time actually goes
Across these studies, the same categories keep returning:
- Note writing. Composing the history, examination findings, assessment and plan, often typed during or after the visit.
- Order entry and coding. Structured fields, billing codes and required forms.
- Inbox work. Results, patient messages, refill requests and administrative notifications.
- After-hours catch-up. Finishing notes that could not be completed between patients.
For specialties that produce long narrative reports, such as radiology, cardiology, and consultation letters in general, note writing is usually the largest single item.
Why this matters for practices in the region
In many clinics across North Africa and the Middle East, physicians still type their own reports, sometimes in two or three languages, without medical secretaries or scribes. The measured burden in well-resourced systems is therefore a cautious baseline, not a ceiling. Time spent on documentation is time not available for patients, teaching or rest. A growing body of research also links EHR workload to professional burnout.
The evidence also suggests where improvement is realistic. Typing is only one part of documentation. Reducing keystrokes through templates, speech recognition or delegation helps. So do agreeing on what a note actually needs to contain and managing the inbox as a team.
Key takeaways
- Independent studies using different methods agree that EHR and desk work take roughly as much of a physician's working time as direct patient care, or more.
- National data from 2024 still show nearly six hours of EHR time per eight hours of scheduled patient care.
- Clerical documentation and inbox management are the two largest blocks of EHR time.
- Measure your own baseline: track for one week how long notes take and how much is finished after hours.
- Target the biggest block first, usually note writing, with templates, dictation or a better division of tasks.
Frequently asked questions
How many hours a day do doctors spend on the EHR?
In a 2017 study of 142 family physicians, EHR use averaged 5.9 hours of an 11.4-hour workday. A 2024 national US analysis found nearly six hours of EHR time per eight hours of scheduled patient care.
What is pajama time in medicine?
It is the informal name for EHR work done after clinic hours, at home in the evening. In Sinsky's 2016 study, physicians reported one to two hours of such work per night.
Which documentation tasks take the most time?
Clerical work (notes, orders, billing and coding) and inbox management make up most EHR time in audit log studies.
Sources
- AHRQ PSNet — Allocation of physician time in ambulatory practice: a time and motion study in 4 specialties (Sinsky et al., Ann Intern Med 2016)
- PubMed — Tethered to the EHR: primary care physician workload assessment using EHR event log data and time-motion observations (Arndt et al., Ann Fam Med 2017)
- Journal of General Internal Medicine — National comparison of ambulatory physician EHR use across specialties (Holmgren et al., 2024)
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General information, checked at the publication date; it is neither medical nor legal advice.