Doctors' time for working with patients and patients' time with doctors

New analyses

The results from the study by Rosta and Aasland have therefore been analysed in light of the rise in the number of doctors in the specialist health service during 2010–14 and the patient volume in same period.

Assessment of doctors’ working hours

Rosta and Aasland merit praise for their study of how hospital doctors spend their working hours, because only few equivalent studies are available (4–7). Although their results are interesting, their sample of doctors may not be representative. Since the distribution of patients among the different specialties varies between outpatient treatment, hospitalisations, elective admissions and emergencies, an average – whether weighted or unweighted – will hardly be representative. Moreover, there is uncertainty as to whether surveys produce answers that correspond to reality.

Time devoted to work with patients

In the study by Rosta and Aasland, the doctors claimed that they had less time available for working with patients than previously. When these results are analysed in light of the patient volume, each patient now has more time with a doctor. The reason is that more doctors and fewer patients more than compensate for each doctor’s experience of having less time available for working directly with patients. The results indicate that especially those patients who are hospitalised or in outpatient treatment are enjoying more time with a doctor, whereas only a small change, or perhaps even a reduction, has occurred with regard to the time that the patients spend with a doctor in outpatient consultations. Because other studies show that hospital doctors spend four times more time on patients who are hospitalised when compared to those in outpatient treatment, it is likely that all patients in total now spend more time with a doctor (4, 5, 7). This is corroborated by the fact that check-ups account for a growing proportion of the outpatients (8). If no reduction in the time available for working with patients had occurred over the study period, patients who were hospitalised and in outpatient treatment would have received 29 % and 5 % more time with a doctor respectively (Table 3).

The doctors’ feeling of having less time available for their patients may arise because they have fewer patients to whom they need to relate, not because they have less time for each patient. With fewer patients, the total time devoted to direct involvement with patients may decline, even though each patient in fact spends more time with a doctor, although with many different doctors. This may be unfortunate in terms of the continuity and quality of the treatment they receive.

Causes of changes in the doctors’ use of time

Rosta and Aasland note a number of reasons why the doctors feel that they have less time available for working directly with patients: The doctors have been assigned tasks that previously were performed by clerical personnel, such as electronic records and speech recognition, and additional requirements for reporting and documentation (1). In a study of electronic records systems, nearly seven out of ten hospital doctors reported that this development took time away from patient treatment (9). Other studies, however, have shown that information technology has helped simplify the documentation and quality improvement efforts (10, 11). Although doctors may spend more time on documentation and quality improvement efforts, this will not impinge on their patient-oriented work, but will rather be a consequence of the fact that less time is required for working with patients.

Rosta and Aasland also pointed out that the hospital doctors’ use of time is affected by the way in which tasks are distributed between different groups of health personnel, for example because doctors now perform more secretarial work (12). On the other hand, nurses have been given a more active function and in many areas they have taken over work that was previously undertaken by doctors. Most likely, this has served to free up the doctors’ time for working with patients in other ways. At the same time, the number of nursing positions in the hospitals has increased at a slower pace than the number of doctors, by 13.7 % and 40.7 % respectively in the period 2003–13 (13). It would therefore be preferable to think that doctors were gradually taking over the responsibilities of nurses, not the other way round.

The doctors’ working hours need to be reorganised

We may reasonably assume that the feeling of having less time available for working with patients is related to the strong increase in the number of doctors relative to the number of patients. At the same time, the doctors’ employment contracts define the doctor as a daytime worker who is exempt from the Working Environment Act. Although the hospitals work around the clock, altogether 83 % of the working hours are in the daytime on weekdays, a period that accounts for no more than 24 % of the total weekly working hours (14). This skewed and impractical distribution of the doctors’ working hours is detrimental for the utilisation of working hours and hospital equipment, and has negative consequences for the number of patients treated and effective resource use (12, 15, 16). Most likely, many hospital department are overstaffed during the daytime and understaffed in the evenings, at night and on weekends (14).

There is reason to assume that the current organisation of doctors’ working hours is inappropriate and that significant changes to the organisation of medical services in the hospitals are called for. It is essential to take a closer look at the matters to which the doctors actually devote their working hours, as well as what they ought to be doing (17), preferably with the aid of objective, quantitative methods rather than qualitative ones.