The following study, published in the Annals of Internal Medicine, examined how physician time is spent in ambulatory practice. Researchers observed 57 U.S. physicians in family medicine, internal medicine, cardiology, and orthopedics in 4 states (Illinois, New Hampshire, Virginia, and Washington) for 430 hours; 21 of the 57 physicians also completed after-hours diaries. The study found that a large proportion of physician time during the clinic day is devoted to nonclinical work. For every hour physicians provide direct clinical face time to patients, nearly 2 additional hours is spent on EHR and desk work. Furthermore, the study found that physicians spend another 1 to 2 hours of personal time each night doing additional computer and other clerical work.