Characterizing radiation oncologist work patterns with a time-motion study

Oncologists face increased demands in their workload from growing administrative and technology-related burdens such as charting and responding to messages. In radiation oncology, where care involves multiple multidisciplinary care touchpoints, these tasks can detract from patient-facing time needed for essential assessments of increasingly complex patients. Pressure to multitask will likely increase without effective workflow optimization. While previous literature has explored system- or process-level workflows in radiation oncology, we sought to characterize physician work patterns in an ambulatory setting to support improved workflow management and patient care. We used an observational time-motion study design to characterize the work patterns of seven attending radiation oncologists and two PGY5 residents at a large urban academic medical center. Each physician was observed for at least nine hours by a trained observer across two to three shifts for a total of 90 hours of observation. Observers recorded the number and type of activities performed within each five-minute interval. Intervals with more than one recorded activity were considered instances of multitasking. To estimate the total amount of time spent performing each activity, we divided the duration of each five-minute interval equally among its recorded activities. Patient visit duration was calculated as the length of an uninterrupted block of patient-facing time. On average, radiation oncologists spent 37.4 ± 9.5% of their time directly interfacing with patients, 39.9 ± 7.4% on patient-adjacent tasks, 10.6 ± 7.9% on administrative work, 2.6 ± 2.2% on personal time, and 9.5 ± 5.4% on tasks categorized as research/other. Patient-adjacent tasks included computer-based work such as charting and responding to messages (18.5 ± 5.1%), interacting with clinical staff (11.3 ± 4.7%), making consults (8.0 ± 6.9%), and interfacing with medical physicists (1.6 ± 2.1%). Physicians multitasked in 53.7% of five-minute intervals. Patient-adjacent tasks contributed to 85.9% of instances of multitasking. Durations of 121 patient visits ranged from 5 to 65 minutes (median 15 minutes). Visits with at least one family member present (n=53) were significantly longer than visits without (n=68) (median 20 vs 10 minutes, p < 0.01, Mann-Whitney U). This preliminary time-motion study reveals a significant burden of patient-adjacent tasks in radiation oncologist workflow. Physicians spent more time on these tasks than on direct patient interactions on average and multitasked in more than half of the observed time intervals. Longer patient visit durations in the presence of family underscore the need to optimize patient-adjacent workload to support complex visits, improve efficiency, and reduce physician burden.