Why is “Pajama Time” still a thing?

According to Forbes, “Administrative burdens such as documenting patient visits, completing billing templates and dealing with insurance companies have become so severe that doctors refer to the practice as late-night “pajama time.” “

Who is most impacted by “pajama time”?

Initially, I was thinking private practices must be the most impacted by this. Not so. Even larger physician groups and academic medicine site physician burnout due to “pajama time”.

What tools do we have at our disposal to combat this issue?

  • Medical Students, Interns, Residents, and Fellows perform majority of physician documentation in the academic setting
  • Advance Practice Providers and Physician Associates (AKA:  PAs) also do heavy documentation lifting, everywhere
  • Advanced EMRs like Epic provide:
    • Templates
    • Dot Phrases
    • Copy Forward/Copy and Paste /Make Me the Author
  • Scribes

Even with all of these tools, “pajama time” is still one of the most pressing issues contributing to provider burnout, even in academic medicine. Why? We have become so focused on documentation to meet the old criteria, that we can’t seem to adjust to meet the new criteria.

What tools do we have that we are underutilizing?

CPT gave us more streamlined guidance in selecting E/M levels. CMS gave us the Patients over Paperwork Act, which aligned with CPT, in reducing the criteria needed to document an E/M service. So why are we still seeing copious amounts of information in the encounter?  All that is required in 2024 is a clinically relevant history (including a chief complaint) and exam, documentation of your MDM, and time if time is used to select the overall level.

What are some of the hazards created by the shortcuts taken to alleviate “pajama time”?

The top two:

  1. Note bloat
  2. Cloned Notes

Final Thoughts

The tools we have available to combat “pajama time” and physician burnout are many. However, the last word of caution pertains to copy and paste and/or cloned notes. Copy and pasting majority of your note has poor optics if you find yourself in a malpractice case according to a CRICO report.

“If you do face a malpractice claim, copying and pasting the same note repeatedly makes you look clinically inattentive, even if the copy/pasted material is unrelated to the adverse event,” CRICO officials noted in a report.”

Final thought, use the EMR to your advantage to focus on your MDM or time-based E/M service. Copy forward only those items you have verified and reviewed during your encounter with the patient. Keep your note patient-specific and clinically relevant. If you write the things that really matter, and leave out the voluminous elements that don’t represent the events of the current encounter, your note will be more concise, easy-to-read, and most importantly, true and accurate.

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