Gender gap is clear in surgeon EHR documentation time, study finds

Women surgeons spend more time working on EHR documentation outside of scheduled work hours than men, despite no difference in clinical workload, according to a study published in BMC Surgery.

Researchers analyzed EHR use data from 323 surgeons across eight departments at Johns Hopkins Medicine in Baltimore from January to December 2023. Thirty-two percent of those evaluated were women.

The study found that women surgeons spent an extra eight minutes a day on EHR work outside of scheduled clinical hours compared to men. Assuming 16 clinical days per month, that equates to approximately 26 hours a year of lost time relative to men.

Extra EHR work for women may exacerbate clinician burnout and contribute to gender disparities in leadership development, salary and academic productivity, according to the report.

Women spent more time on notes, messages and clinical review than men. However, there were no gender differences in clinical workload, care team documentation support, number of patient messages, documentation length or EHR proficiency.

“We specifically studied gender differences in clinical support for EHR work, note length and EHR proficiency because these are modifiable factors,” researchers wrote. “However, none were related to surgeon gender. Thus, women conduct their EHR work outside of regular working hours due to other issues.”

The authors suggested one contributing factor to the gender gap could potentially be if surgeons have an unequal distribution of responsibilities at home, citing previous research that many female surgeons are tasked with greater household duties than their male counterparts.

“Published research indicates that many women surgeons and physicians still do their family and household tasks -- including family care, meal preparation, cleaning and other household duties -- in addition to their professional work,” they said. “Thus, many women surgeons must do their EHR documentation and answer patient messages outside of regular working hours, including very early in the morning and late at night.”

The BMC Surgery findings aligned with some previous studies showing these disparities exist outside of nonsurgical medical specialties as well. A 2022 study from Athenahealth found that across a wide variety of specialties, women clinicians spend a higher percentage of their EHR documentation time outside of patient appointment hours compared to men clinicians.

The hard question, however, is how to alleviate these issues. Researchers from the BMC Surgery suggested strategies to help surgeons who have family care responsibilities, including mentorship, coaching and open dialogue about work-life integration. Institutional support with finding high-quality child or elderly care and pro-rating clinical requirements after childbirth recovery and parental leave would also be useful, the study said.

Additionally, supervisors should ensure equitable distribution of clinical duties, such as call and weekend shifts.

The authors emphasized that institutional leaders and surgical societies should lead discussions on the EHR gender gap to drive collective solutions.

“The data must be measured over time to ensure that the gap decreases,” they wrote. “Tracking EHR data with the same vigilance that the American Association of Medical Colleges reports gender differences in salary, rank and high-level leadership might encourage institutions to reduce the EHR gender gap or provide compensation when afterhours EHR work is necessary.”

The researchers acknowledged several study limitations, including its retrospective single-center design. They also pointed out that their data did not include percentages of EHR work conducted using mobile apps, which should be incorporated into future research.

Hannah Nelson has been covering news related to health information technology and health data interoperability since 2020.