Gender Differences in EHR Use Reveal Clinician Burnout Concerns

Female physicians spent more time on EHR clinical documentation compared to their male counterparts, according to a study published in JAMA Network Open that raises concern for a gender gap in clinician burnout.

Researchers conducted the cross-sectional study in a large ambulatory practice network using 2018 to 2019 EHR data for 318 physicians.

Overall, female physicians spent 5.9 hours on the EHR per day on average, compared to male physicians who spent 5.3 hours using the EHR each day.

The researchers found that clinical documentation is the primary activity driving gender differences in EHR time.

Female physicians spent 2.1 hours on clinical documentation per day on average, while male physicians spent 1.7 hours.

The study authors said these differences persisted after accounting for hours worked and physician specialty, despite female physicians caring for slightly fewer patients on average.

The research also revealed that female physicians spent more time on the EHR outside scheduled work hours than male physicians (0.9 hours vs 0.8 hours).

“Our findings provide a potential mechanism for the gender gap in burnout, which has implications for workforce mental health and physician retention,” the authors wrote. “They suggest that women physicians may benefit from policy changes, workflows, and technologies that reduce documentation burden, including scribes, team documentation, and artificial intelligence-powered solutions.”

Limitations of the study include derivation of data from a single, nonteaching practice network and availability of data only from before December 2019.

Future studies should explore workflow and health IT interventions that can reduce time spent on the EHR, focusing on interventions that reduce clinical documentation burden, the study authors suggested.

A separate editorial article published in JAMA Network Open noted that the study’s findings support a growing body of research on gender differences in EHR use.

A recent analysis by Rittenberg et al using 2019 EHR data at Brigham and Women’s Hospital found that women primary care physicians spent more time working in the EHR, partially because they received about 25 percent more in-basket messages than their male counterparts.

The editorial authors suggested that these observed gender differences could be due to inherent and socialized physician traits and gendered differences in patient and staff expectations of physician accessibility.

They noted that these differences in EHR work time represent uncompensated labor that is not captured in the already sizeable gender wage gap. Additionally, the added hours likely contribute to higher rates of clinician burnout in women physicians.  

“Acknowledging that some of this EHR time is valuable asynchronous care that patients have increasingly come to expect, clinical practice leaders might formally incorporate this work into clinician workflows, for example, by designating the first 30 minutes of clinic sessions for responding to patient messages,” the editorial authors wrote.

“In parallel, practices can guide patients to use messages in more targeted ways, involve other clinical team members, and use artificial intelligence to triage messages,” they added.

The authors also said that compensation models must adapt to the reality that care is increasingly asynchronous, especially for female providers.

“Current predominant fee-for-service payment models woefully undervalue time spent inside and outside of visits,” they wrote. “Moving away from incremental fee-for-service payments, future models might pay physicians a lump annual sum per patient, risk-adjusted for aspects of clinical complexity that are relevant to ambulatory care, such as use of secure messages.”