Pajama time and burnout: the burden of after-hours electronic health record use on family medicine residents

Working on the electronic health record (EHR) after usual clinic hours (pajama time) is associated with burnout and decreased professional satisfaction in attending physicians. This study examines the association between resident pajama time and burnout, professional satisfaction, and medical knowledge among family medicine (FM) residents.A cross-sectional survey of US FM residents was administered by the American Board of Family Medicine after the 2024 In-Training Examination in October 2024. The survey included questions about EHR use and satisfaction along with multiple other measures, including assessment of burnout with a 2-item screening measure and professional and training satisfaction. High pajama time was defined as an average of 3 hours or more per night on ambulatory EHRs. Bivariate analysis of outcomes by high EHR use and multiple logistic regressions were performed.The survey was administered to 9,731 FM residents who reported being postgraduate year 2 or above. Of the 9,653 residents who answered the EHR questions (response rate, 99.1%), 3,124 (32.3%) reported high pajama time. High pajama time was more common in older, female, underrepresented in medicine, and international medical graduate residents. After these characteristics were controlled for, high pajama time was associated with lower examination scores (odds ratio [OR], 1.28; 95% CI, 1.15-1.41), decreased odds of professional satisfaction (OR, 0.61; 95% CI, 0.55-0.68), training program satisfaction (OR, 0.62; 95% CI, 0.56-0.70), and higher odds of burnout (OR, 1.61; 95% CI, 1.46-1.78).Nearly one-third of upper-year US FM residents report spending 3 hours or more per day working after hours on ambulatory EHRs. This high pajama time is associated with lower medical knowledge, lower professional satisfaction, and higher burnout. Residency programs should implement strategies at the system and learner levels to reduce after-hours EHR use to prevent long-term negative effects on physician well-being and professional practices.