A recent study in Annals of Internal Medicine showed that on average Primary Care Internists spend approximately 61.8 hours per week in the care of patients, well beyond the actual face to face with those they care for. This is actually below the estimated 26.7 hours / DAY that estimates the time needed to prvide optimal care! How does this resonate with you all in Primary Care?

Highlights

• The issue of seemingly infinite clinical work likely extends beyond primary care to other intensive outpatient specialties like medical oncology.
• For some primary care physicians, the extensive time commitment is an inherent and accepted part of providing high-quality patient care.
• Increased work hours can be viewed positively as a dedication to continuous learning and deep research for optimal patient care.

Expert Insights

The Discrepancy Between Time and Optimal Care

A recent study in the Annals of Internal Medicine has given quantitative weight to a reality long understood by clinicians: Primary Care Internists dedicate approximately 61.8 hours per week to patient care. The report’s more arresting finding, however, is the calculation that providing ideal, guideline-directed care would require a staggering 26.7 hours per day. This stark gap between the physician's workweek and the theoretical demands of optimal care is prompting a critical conversation about the nature and sustainability of contemporary medical practice.

A Re-evaluation of Time: Burden or Dedication?

While long hours are often framed as a symptom of burnout and system inefficiency, some physicians view this time investment through a different lens. Dr. Fletcher Bell, an Internal Medicine PCP and Chief Resident, posits that this commitment is, in fact, central to the physician’s role. "I think this is the work!" he asserts, suggesting that the hours logged beyond face-to-face encounters are filled with the essential tasks of delivering superior care. He notes that in an era with a "sea of resources," clinicians are constantly engaging in continuing education and deep investigation of specific topics to best serve their patients. Dr. Bell challenges the purely negative connotation of an extended workweek, proposing an alternative perspective: "What if more time = good?" This re-frames the additional hours not as a burden, but as a marker of professional dedication to clinical excellence.

"What if more time = good?" Dr. Fletcher Bell

A Shared Challenge Across Specialties

The phenomenon of a seemingly endless workload is not perceived to be unique to primary care. This sentiment is echoed by Dr. Timothy Ellis-Caleo, a specialist in Thoracic Oncology, who wonders how these findings translate to other intensive, non-procedural outpatient fields. His experience in medical oncology suggests a parallel reality where the demands of patient care expand well beyond scheduled appointments. "It seems like there is essentially an infinite amount of clinical work to be done even within a fixed patient volume," Dr. Ellis-Caleo observes. This insight points to a broader characteristic of complex cognitive specialties, where care coordination, research, and communication create a scope of work that is functionally limitless.

"It seems like there is essentially an infinite amount of clinical work to be done even within a fixed patient volume." Dr. Timothy Ellis-Caleo

Synthesizing the Physician Experience

Viewed together, these perspectives create a nuanced portrait of the modern physician’s workload. Both Dr. Bell and Dr. Ellis-Caleo recognize the profound time commitment inherent in their fields. Dr. Bell’s commentary highlights the intrinsic professional motivation that drives this investment, linking the long hours directly to the pursuit of high-quality, individualized patient care. Dr. Ellis-Caleo, in turn, broadens the context, suggesting that this is a systemic issue affecting specialties where clinical responsibility is vast and not easily contained. The consensus is that the time deficit identified by the study is not an aberration but a fundamental feature of a healthcare landscape where the ideals of comprehensive care consistently outstrip the finite hours in a day.