Gender gap in EHR use among PCPs continues to grow, study finds

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December 12, 2022

2 minute read

Disclosures:
Rule does not report any relevant financial information. Please see the study for relevant financial information from all other authors.


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According to a study published in the Journal of General Internal Medicine.

“The gender gap in EHR use is growing, especially for note writing, inbox management, and time outside of scheduled clinical hours,” Adam Rule, PhD, an assistant professor at the University of Madison-Wisconsin Information School, and his colleagues wrote.

PC1222Graph_Rule_01_WEB

Data derived from: Rule A, et al. J Gen Med Intern. 2022; doi: 10.1007/s11606-022-07837-2.

To assess trends in electronic health record (EHR) use among PCPs, “who use EHRs more than physicians of other specialties,” the researchers collected monthly data from April 2019 to March 2022 from of Epic Systems, a private healthcare software company.

Rule and his colleagues used five metrics to determine gaps in EHR use: total EHR time, time in notes, time in orders, time in inbox, and time outside of scheduled clinic hours. These measures were analyzed by model-adjusted and unadjusted comparisons.

The analysis included responses from 160 PCPs, of which 108 were women. All participants practiced at the University of Wisconsin Academic Medical Center during the study period.

From April 2021 to March 2022, researchers found that female physicians averaged an unadjusted average of 7 hours of total EHR time, compared to an average of 5.3 hours for male physicians (P < .001).

Female physicians also spent more time in notes (2.5 vs. 1.4 hours; P < 0.001), time spent in inbox (1.3 vs. 1 hour; P = 0.001) and time outside scheduled clinic hours (3.1 vs. 2 hours; P < 0.001) compared to their male counterparts.

In adjusted comparisons, female physicians had higher averages of:

  • total EHR duration (1.5 hours; 95% CI, 0.7-2.4);
  • total time in grades (0.9 hours; 95% CI, 0.5-1.4);
  • total time spent in inbox (0.2 hours; 95% CI, 0.1-0.4); and
  • total time outside clinic hours (1.1 hours; 95% CI 0.4-1.8).

According to the researchers, the only measure for which women did not spend significantly more time doing adjusted and unadjusted analyzes was time spent in orders.

When examining how EHR usage has changed over time, Rule and his colleagues reported that between 2019 and 2021, the gap increased by:

  • 8.3 minutes per year for total EHR time (95% CI, 4.6-11.9);
  • 6.1 minutes per year for time spent on notes (95% CI, 4.1-8);
  • 3.3 minutes per year for time spent in the inbox (95% CI, 2.2-4.4); and
  • 6.6 minutes per year for time outside scheduled clinic hours (95% CI, 2.7-9.6).

The researchers noted that the disparities in EHR use are greater than those reported in previous studies, a development that “may be due to differences in healthcare systems, time periods, or observed specialties,” they wrote.

Rule and his colleagues also expressed concern about the time gap outside of scheduled clinic hours given the links between burnout and EHR use outside of work hours. A 2017 study in the Journal of Higher Medical Education found that 75% of PCPs attributed burnout to EHR time, and those who spent more than 6 hours per week on EHR time were 2.9 times more likely to report burnout.

“It is essential that health systems explore the root causes of these differences and develop solutions to address them taking into account the greater burnout among female physicianswrote Rule and his colleagues.

The researchers proposed several potential solutions, including additional documentation and inbox support, reduced patient contact, and reduced panel size. They concluded that future research should further examine gender gaps in EHR in other areas “and the impact of targeted interventions to reduce the burden of EHR for female physicians.”

References:


Perspective

Back to the top

Eve Rittenberg, MD

This study by Rule and colleagues adds supporting evidence that female primary care physicians have a greater amount of work done in the EHR compared to male PCPs.

Over time, the EHR has become a bigger part of doctors’ workload – doctors now spend a large part of their days responding to patient messages and calls, reviewing lab results and imaging, ordering tests, writing notes, and clicking reminders and notifications.

One finding of this study, which is particularly important, is the large gender difference that ruler colleagues document in WOW (work outside of work), i.e. time spent in the EHR outside of work. scheduled clinical hours. We know that female physicians have higher burnout rates than male physicians. This study sheds light on one of the factors contributing to the higher rate of burnout among women: you can imagine that if work encroaches on evenings and weekends, time that might otherwise be spent on activities that improve well-being, then there will be consequences for the likelihood and severity of burnout.

This study—like the one we conducted at Brigham and Women’s Hospital in Boston—showed that PCP women spent more time working in notes and the inbox, but not in orders. This pattern suggests that the gender difference in time spent on the EHR is not due to differences in proficiency or effectiveness in using the EHR. Thus, the findings imply that efforts to coach physicians in the effective use of the EHR will not resolve the gender gap in work time. Our study documented an increased volume of messages from patients and staff to female PCPs – this increased workload is a root cause of gender differences in EHR work hours. Thus, strategies to address the higher number of hours that female physicians spend in the EHR must focus on the influx of messages that they face.

Reference:

Rittenberg E, et al. J Gen Med Intern. 2022; doi: 10.1007/s11606-021-07298-z.

Eve Rittenberg, MD

Primary Care Physician, Brigham and Womens Fish Center for Womens HealthAssistant Professor of Medicine, Harvard Medical School

Disclosures: Rittenberg does not report any relevant financial information.


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