The People's Perspective on Medicine

What Do Interns Do All Day?

A new time-motion study finds that interns spend far more time in front of computers than they do interacting directly with patients.

Interns are medical doctors who have completed four years of medical school but need an additional year of training. They get that by working in a hospital before they go on to practice medicine or specialize. The goal is to further their education, and in particular, to provide a lot of hands-on contact with patients.

Time-Motion Study of Medical Interns:

A new time-motion study suggests that interns spend surprisingly little time in direct patient care (JAMA Internal Medicine, April 15, 2019). The researchers analyzed how 80 interns spent their time over 194 shifts. The volunteers logged direct and indirect patient care, education, medical rounds, handoffs and miscellaneous activities. Investigators analyzed records for 2,173 hours altogether.

About two-thirds of the trainees’ time was spent participating in indirect care, mostly interacting with computers. Only three hours a day involved direct patient care.

How Has Time Allocation Changed?

Spending more time on a computer than examining or talking to patients may seem like a new phenomenon. However, interns have been allocating their time in roughly the same way for more than a decade. A study at Johns Hopkins University published in 2013 found that interns spent 64 percent of their time in indirect patient care and 12 percent of their time in direct patient care (Journal of General Internal Medicine, Aug. 2013). That is fairly similar to the time allocation uncovered by the current study. 

Even 20 years ago, interns and residents spent more time doing indirect care (56 percent) than they did in direct patient care (14 percent). About 30 percent of their time was spent in administrative activities (Journal of General Internal Medicine, Aug. 1998).

Consequently, it seems that the allocation of time and energy has changed relatively little over the last few decades. However, these studies do not show whether this is the ideal way for interns to prepare themselves for a future in patient care. In addition, the investigators did not inquire whether spending more time in documentation and other forms of indirect patient care helps doctors in training keep patients safer. 

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About the Author
Terry Graedon, PhD, is a medical anthropologist and co-host of The People’s Pharmacy radio show, co-author of The People’s Pharmacy syndicated newspaper columns and numerous books, and co-founder of The People’s Pharmacy website. Terry taught in the Duke University School of Nursing and was an adjunct assistant professor in the Department of Anthropology. She is a Fellow of the Society of Applied Anthropology. Terry is one of the country's leading authorities on the science behind folk remedies. .
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  • Chaiyachati et al, "Assessment of inpatient time allocation among first-year internal medicine residents using time-motion observations." JAMA Internal Medicine, online April 15, 2019. DOI: 10.1001/jamainternmed.2019.0095
  • Block et al, "In the wake of the 2003 and 2011 duty hours regulations, how do internal medicine interns spend their time?" Journal of General Internal Medicine, Aug. 2013. DOI: 10.1007/s11606-013-2376-6
  • Dresselhaus et al, "Analyzing the time and value of housestaff inpatient work." Journal of General Internal Medicine, Aug. 1998.
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Interns are still basically slave labor. The hours they can be forced to work are brutal, even though they have been limited and adjusted in the last few years. Mostly they are used as secretaries to the nurses and doctors, and receive little experience in true patient care. It’s a hazing experience similar to frats and sororities, and needs to be completely overhauled.

I think personal interaction is much more important. I’m not saying that hitting the computer doing research is not important because it is. But were they spending all the time doing research? Well we don’t know, do we.

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