Results On average, general practitioners have 29 minutes each workday to discuss preventive care services (just over two minutes for each clinic visit) with patients, but they need about 6.1 hours to complete shared decision making for preventive care. 100% of the study sample experienced a prevention-time-space-deficit (mean deficit 5.6 h/day) even given conservative (ie, absurdly wishful) time estimates for shared decision making. However, this time deficit could be easily overcome by reducing personal time and shifting gains to work tasks. For example, general practitioners could reduce the frequency of bathroom breaks to every other day and skip time with older children who don’t like them much anyway.

Introduction

A widely held presumption is that general practitioners have too much to do and too little time.1234567 Strangely, no research has asked the obvious follow-up questions: Have they no evenings? Have they no weekends? As with most humans, doctors seek out the course of action that uses up as little time and energy as possible8—in other words they are lazy (see the trigger warning at the end of the article before proceeding). Doctors therefore have a large, untapped reservoir of time. The central challenge of disruptive healthcare leadership, then, is to find ways of tapping into that reservoir and draining it dry. Draining stagnant time allows managers to refill a doctor’s workday to the brim with fresh streams of important new clinical tasks! For example, one fewer toilet breaks enable the completion of as many as five additional clinical alerts (up to 10 more for older men).

Despite having an untapped reservoir of time, doctors never stop mewling about the time needed for shared decision making,9101112 especially for preventive care. Shared decision making is defined by the US Preventive Services Task Force (a panel of experts who make evidence based recommendations on preventive care services) as “a particular process of decision making by the patient and clinician in which the patient: 1) understands the risk or seriousness of the disease or condition to be prevented; 2) understands the preventive service, including the risks, benefits, alternatives, and uncertainties; 3) has weighed his or her values regarding the potential benefits and harms associated with the service; and 4) has engaged in decision making at a level at which he or she desires and feels comfortable.”12 Asking doctors to engage in shared decision making for preventive services is like asking a toddler to share candy with a sibling; no matter how big the bag there’s going to be moaning and wailing. A recent study reported that doctors spent an average of only 59 seconds on shared decision making for lung cancer screening, despite it being known by experts that five minutes is the absolute minimum.13 Even without shared decision making, doctors still grouse about a lack of time to deliver basic preventive care.141516 Yet, few studies have examined the basis for these whimpering protestations. One study estimated that to deliver all recommended preventive services to a typical patient panel, doctors need an average of 7.4 hours each workday.17 This average seems large, but one working day is a tiny slice of a doctor’s time on the planet. Cutting back on weekend naps could solve the problem entirely! Careful review of what is known about the daily lives of doctors is the only way to tell whether these “time-deprived” grievances lack credence. So, following in the long tradition of data driven management, we commissioned a study to quantify precisely what we already know—that doctors have vast amounts of time for thumb twiddling.

At a moment when doctors are shirking responsibilities while grumbling that their overlords are unreasonable in demanding more, it has become urgent to examine the actual life of the doctor. We carried out a microsimulation study to examine their time management and how this affects shared decision making for highly recommended preventive interventions.