Measurement and analysis of intraservice work

The work that physicians perform represents a major resource input to medical services and procedures. In this article we describe the concepts of work and its dimensions, as well as the methods developed to measure them. We also describe the design and results of a national probability survey of physicians in 18 specialties. We present the results—estimated values of work and its dimensions—for selected services. Our findings indicate that physicians can give reliable and valid ratings of work and that we can model this work as a function of four dimensions: time, mental effort and judgment, technical skill and physical effort, and stress. Analyzing the complex functional relationship between work and these four dimensions shows that all four dimensions are important and statistically significant in predicting work. Time is a more important dimension in predicting work for medical specialties than for surgical specialties, with the estimated regression coefficients between.3 and.5 and.2 and.3, respectively. In contrast, technical skill is a more important dimension in predicting work in surgical specialties than for medical specialties, with the estimated regression coefficients between.3 and.5 and.2 and.3, respectively. Finally, we found that an exponential equation of the four dimensions precisely describes total work. (JAMA1988;260:2361-2370)