Changes In Primary Care Physicians’ Electronic Health Record Patterns After They Reduced Clinical Visit Volume

Primary care physicians face increasing workload pressures. Some are delivering fewer patient visits, potentially in response to these pressures. However, the relationship between reduced visit volume and overall workload is unclear. Using national Epic electronic health record (EHR) metadata from the period 2019-22, we examined changes in EHR usage and patient characteristics among 772 primary care physicians who reduced monthly visits by 10 percent or more, compared with 16,477 primary care physicians who did not. One year postreduction, reducers' monthly visits fell by 32.6 percent relative to those of nonreducers, but EHR time declined by just 21.2 percent, which increased EHR minutes per visit by 21.3 percent. Electronic inbox messaging and EHR time outside of scheduled hours per visit also rose, and reducers' patient panels became more complex. When primary care physicians reduced visit volume, they reduced EHR use by less than the reduction in visit volume. Our findings highlight the persistence of asynchronous EHR work in primary care even when fewer visits occur. Innovative approaches are needed to enable the efficient delivery of asynchronous primary care.