The effect of electronic health records (EHRs) and increased regulatory requirements on physician time spent in patient care and related activities is carefully studied in this observational study funded by the American Medical Association. Trained observers documented the activities of 57 physicians from 16 practices in four states. The practice specialties included internal medicine, family medicine, cardiology and orthopedics. In addition to over 430 hours of observation during office hours, 21 physicians also self-reported after-hours work activity for seven consecutive days using a diary. The investigators found that, on average, for every office hour spent on direct clinical face time with patients, physicians spent almost two additional hours on EHR and other desk work. Less than one-third of the total office day was spent on direct clinical face time with patients while nearly half of the total office day was spent on EHR and desk work. Physicians also self-reported spending 1-2 hours of personal time at home each night using the EHR and on other work tasks. While this study did not collect data on physician burnout and dissatisfaction, the authors suggest that increasing demands associated with EHRs and other regulatory requirements have had unintended negative consequences including decreased time physicians spend engaging with patients.