6. Recommendation 1

Protected non-clinical time must not include administrative duties related to patient care.

Justification
Girod et al note that competing time demands and lack of support for their scientific work are a top reason for academic faculty leaving practice (33).  Many clinical teachers similarly note that they do not feel they have sufficient time to teach (Schiekirka-Schwake et al, Huwendiek et al).  In a 2014 cross-sectional study of US physician work hour distribution, Woolhandler and Himmelstein note that family physicians spent approximately 8 hours or 17% of their time in administrative work (Woolhandler and Himmelstein).  Studies examining both outpatient (Sinsky et al, Young et al) and inpatient (Kara et al) time use note similar amounts of administrative work stemming from direct patient care or resident supervision.  This time, which we define as “spillover time” or “work after clinic” must be considered separately from protected nonclinical time.  Grouping spillover work with protected nonclinical time in an allocation category such as “administrative time” risks eroding the time faculty should dedicate to important nonclinical activity such as designing curricula, designing and conducting research, and participating on key residency management committees.  Thus, we advocate that health systems and residency programs distinguish these two entities separately and provide adequate time for the performance of both duties.