The real cost of "pajama time": what documentation is doing to medicine
Every physician knows the phrase, even if they've never said it out loud. "Pajama time" is the charting that follows you home — the notes finished at the kitchen table, after the kids are asleep, in the hour that used to belong to you. It has become so normal that it's easy to forget how strange it is: a profession where the workday quietly annexes the evening, one unfinished note at a time.
The numbers are worse than the vibe
The landmark time-motion study in this area, published in the Annals of Internal Medicine in 2016 (Sinsky and colleagues), found that for every hour physicians spent in direct clinical face time with patients, they spent nearly two additional hours on EHR and desk work during the day — plus another one to two hours of personal time on computer work at night. Later studies of after-hours EHR use put pajama time at more than an hour on the average clinic day, with weekends not spared.
And the burden doesn't fall evenly. Among more than 9,000 residents surveyed, those reporting three or more hours of after-hours EHR work per night were significantly more likely to experience burnout. Surveys of practicing physicians now rank documentation and charting among the top drivers of burnout — ahead of most of the bureaucratic frustrations that usually get the blame.
Why small practices feel it most
A large health system can hire scribes, build float pools, and negotiate EHR customizations. An independent physician is the documentation department. Every note you don't finish in the room is a loan you make to your evening — and independent practices have no one to refinance it with. That's part of why documentation relief tools spread through big systems first: not because small practices need them less, but because the big systems could afford the early versions.
What actually helps
The honest answer from the research: several things help a little — better EHR training, team documentation, template hygiene — and one category of intervention is showing outsized early results. Ambient AI scribes, which draft the note from the visit conversation itself, have shown reductions in total EHR time and note-composition time in controlled evaluations, and a 2025 study across two health systems reported meaningfully lower burnout among users. Researchers rightly caution that time saved doesn't automatically become well-being — it depends on where the saved time goes and whether the drafts are trustworthy enough that review doesn't become its own chore.
But the underlying logic is sound. Pajama time exists because composing a note is a second job performed after the first one. Remove the composing — keep the reviewing and signing — and the second job shrinks to minutes.
A simple test for any documentation tool
Ask one question: where does the note stand when the visit ends? If the answer is "waiting for you to write it," the tool hasn't changed the economics of your evening. If the answer is "drafted, waiting for your review," it has.
About Visit to Chart — VTC is an ambient AI clinical scribe for telehealth, built for independent and small practices. The draft note lands minutes after the visit ends, and it is built to handle long visits too. Learn more or request access.
Sources
- Pajama Time: Working After Work in the Electronic Health Record (PMC)
- Doctors work fewer hours, but the EHR still follows them home (AMA)
- After-hours EHR use associated with resident burnout (Yale School of Medicine)
- Why EHR documentation is a leading cause of physician burnout (The Intake)
- Are ambient AI tools the key to reducing physician burnout? (Advisory Board)