ORIGINAL RESEARCH
Nitya L. Thakore, MD; Rebecca S. Etz, PhD; Erin Britton, PhD, MPH; Denee J. Moore, MD; Asaf Bitton, MD, MPH; Kurt C. Stange, MD, PhD; Ishani Ganguli, MD, MPH
Corresponding Author: Tristen L. Hall, PhD, MPH; Ishani Ganguli, MD, MPH, Brigham and Women’s Hospital, Division of General Internal Medicine and Primary Care.
Email: iganguli@bwh.harvard.edu
DOI: 10.3122/jabfm.2026.260024R1
Keywords: Health Policy, Linear Models, Primary Health Care, Self Report
Dates: Submitted: 1/17/2026; Accepted: 04/13/2026
Status: In Press.
INTRODUCTION: Efforts to improve primary care payment require understanding the scope of activities needed to deliver high-quality primary care. We quantified clinician time spent on a range of primary care activities and how this differed by clinician and practice characteristics.
METHODS: We conducted a nationally administered survey of primary care clinicians (January 10-18, 2025) on self-reported minutes per day spent on non-visit activities (i.e., historically unreimbursed activities outside of face-to-face patient visits) at patient and practice levels. We compared non-visit time by patient and practice characteristics using multivariable linear models. We examined additional time needed to address common topics that arise during a typical follow-up visit for an adult with a well-controlled chronic condition.
RESULTS: The survey response rate was 64.1% (417/651). The 401 clinicians in the final sample spent mean(SD) 159.8(100.1) minutes per day on non-visit activities, including 124.3(73.3) minutes for patient-level activities (e.g., answering patient messages/questions) and 35.5(42.5) minutes for practice-level activities (e.g., team development). Female clinicians, Hispanic clinicians, and those participating in accountable care organizations reported more non-visit time than their respective counterparts. Clinicians needed between 6.1(4.4) and 14.5(8.1) additional minutes beyond the 25-minutes allotted for a follow-up visit to address any 1 of 12 common topics.
CONCLUSIONS: In this survey, primary care clinicians reported nearly 3 hours daily on historically unreimbursed non-visit work, of which nearly one-quarter was at the practice-level, and up to 15 additional minutes per added topic during office visits. These estimates can inform efforts to better support these activities through payment reforms.