Quick Links

Easing Workload Burden

When less means more time for what counts.

Not every test or treatment leads to better care. Low-value tests and treatments, which offer little or no benefit, can take time away from appropriate care, increase clinician workload, and place additional strain on health systems and the environment.

As health care providers across the country face growing workload challenges, reducing low-value care is a practical way to ease the burden and focus on what patients need most.

Time Needed to Treat

Clinician time is a limited resource. The Time Needed to Treat (TNT) concept encourages providers to prioritize time as carefully as any other aspect of care. It was developed by Dr. Minna Johansson, Dr. Gordon Guyatt, and Dr. Victor Montori.

To put this concept into practice, the Time Needed to Treat Calculator was developed to estimate how much clinician time may be spent on low-value care. It may help you choose a less time-consuming approach when the benefits are similar between different options. 

Need help using the calculator? Watch our demo.

How to use the calculator ?

When the calculator asks for a number, assume the time is in minutes, and do not provide units or decimals or percentage symbols.
What are you trying to calculate the ''time needed to treat'' for ?
There are three ways TNT can be calculated
1. By using the percentage of your patients who have a specific condition or who would be eligible to an intervention for which you want to calculate the TNT (this is ideal to estimate time needed to treat associated with screening)
2. By specifying how often you encounter a situation or perform an action on a monthly basis
3. By using using population-based parameters (this is ideal when planning a public health or large-scale intervention)
How would you like to estimate how many patients this would apply to in your practice ?

How many patients do you have in your roster ?
To what percentage of your patients does the recommendation apply ? (%)
How long does discussing / prescribing or doing the intervention take you with each patient, on average (minutes) ?
What is the percentage of test results that come back abnormal (%) ?
Estimates for common tests
How much time does discussing and planning follow-up for normal results take you on average (minutes) ?
How much time does discussing and planning follow-up for abnormal results take you on average (minutes) ?
Every how many years should the intervention be performed ?
For example, if the intervention is screening and should be done every year, put ''1'' ; if the intervention should be performed more than once a year, provide a decimal (e.g. 0,5 for screening every 6 months)
We estimate it would take you the following time (provided in hours) to perform this intervention one time, including time to manage normal and abnormal results for all your eligible patients, on a monthly basis :
We estimate it would take you the following time (provided in hours) to perform this intervention one time, including time to manage normal and abnormal results for all your eligible patients, on a yearly basis :
We estimate it would take you the following time (provided in hours) to perform this intervention over a 25 year period of time with the specified interval, including time to manage normal and abnormal results for all your eligible patients :

How many time do you perform or recommend this intervention per month, on average ?
How much time does the intervention take (prescribing the test or treatment, including discussing it and or performing it, if applicable) ?
If this is a test or a physical exam, on what percentage of occasions does it reveal something abnormal (%) ?
Leave this field empty if this does not apply / the intervention is not related to testing
Estimates for common tests
How long does managing normal results take you on average (minutes) ?
Leave this field empty if this does not apply / the intervention is not related to testing
How long does managing abnormal results take you on average (minutes) ?
Leave this field empty if this does not apply / the intervention is not related to testing
We estimate it would take you the following time (provided in hours) to perform this intervention every month, including time to manage normal and abnormal results :
We estimate it would take you the following time (provided in hours) to perform this intervention every year, including time to manage normal and abnormal results :
We estimate it would take you the following time (provided in hours) to perform this intervention over a 25 year period, including time to manage normal and abnormal results :

What is the population size ?
To what percentage of of the population does the recommendation apply ? (%)
If you have a direct number you would like to input, you can simply specify it in the ''Population size'' box, and write 100 % in the percentage of the population the recommendation applies to.
How long does discussing / prescribing or doing the intervention take with each patient, on average (minutes) ?
What is the percentage of test results that come back abnormal or call-back rate (%) ?
Estimates for common tests
How much time does discussing and planning follow-up for normal results take on average (minutes) ?
How much time does discussing and planning follow-up for abnormal results take on average (minutes) ?
Every how many years should screening be performed ?
If screening should be performed more than once a year, provide a decimal (e.g. 0,5 for screening every 6 months)
We estimate it would take the following time (provided in hours) to perform this intervention one time, including time to manage normal and abnormal results for all eligible patients :
We estimate it would take the following time (provided in hours) to perform this intervention over a 25 year period of time with the specified screening interval, including time to manage normal and abnormal results for all eligible patients :
We estimate implementing the measure, including time to manage normal and abnormal results for all eligible patients, requires this number of full-time clinicians every year, assuming a person works 40 hours per week, 48 weeks per year :

Reflecting on your "time needed to treat" (TNT) calculations can be a pivotal moment in your clinical practice. This exercise goes beyond numbers—it challenges us to think critically about the value and timing of the tests and treatments we recommend. How did your results compare to your expectations? Were there instances where you reconsidered the benefit of a specific intervention in relation to the time investment? Is there solid evidence to support the intervention? Reflecting on these questions, and considering potential harms, helps us align our clinical decisions with evidence-based practices, ultimately improving patient outcomes.

As you process this, consider the principles of the Choosing Wisely campaign, which advocates for reducing unnecessary interventions and focusing on what truly benefits patients. Are there areas of your practice where you might streamline treatment or reconsider the timing of interventions? Access resources on Choosing Wisely Canada's website to guide your reflection.

Lastly, reflection is not just an intellectual exercise; it's an opportunity for professional growth. If you're a family physician, consider utilizing tools like the CFPC's Mainpro Linking Learning Exercises, where reflective practice can be tied to continuing professional development (CPD) credits. If you're a Quebec physician, this can be used to claim category ''B'' credits.

If you're a specialist, explore the Royal College for similar reflective learning tools to support your ongoing education.

This process can facilitate real change, helping you break down barriers to implementing insights gained from exercises like TNT. By downloading a PDF summary of your TNT calculations, you can use this as a concrete reference in future reflective exercises, ensuring that the insights gained today are put into practice in your future clinical decision-making.
Should be Empty:

Examples in Practice

Below are examples of existing Choosing Wisely Canada recommendations to help you get started.

Don’t order Dual-Energy X-ray Absorptiometry (DEXA) screening for osteoporosis in low-risk patients. Use “risk-assessment first” screening before ordering DEXA.
1

Time saved: A risk-assessment-first screening approach using FRAX for women aged 65 and older saves at least 150 hours over 25 years, or 6 hours per year, compared to starting with DEXA screening. This approach aligns with patient values and preferences while minimizing clinician time.
Don’t do imaging for lower back pain unless red flags are present.
2

Time saved: Imaging of the lower spine before 6 weeks does not improve outcomes. A tailored approach to lower back pain, based on evidence regarding the appropriate timing for imaging and the absence of red flags, saves 1 hour per month, 1 day per year and 5 weeks in a career. This approach reduces unnecessary imaging, benefiting both patients and the health care system.
Don’t do annual screening blood tests unless directly indicated by the risk profile of the patient.
3

Time saved: Avoiding unnecessary CBC tests when there is no clinical indication aligns with evidence-based practice. It saves 1.5 hours per month, 2 days per year, and 8 weeks over a career. This approach also reduces the risk of over testing and potential harm to the patient.
About the Calculations

Some data are difficult to estimate precisely and can vary across settings. While this is a potential limitation, the Time to Treat Calculator is designed to support reflective practice rather than provide an exact measure of the time that could be reallocated to higher-value care. It helps clinicians consider how time is spent and where changes could have the greatest impact.

Sources:

About Choosing Wisely Canada

Choosing Wisely Canada is the national voice for reducing unnecessary tests and treatments in health care. One of its important functions is to help clinicians and patients engage in conversations that lead to smart and effective care choices.

Web: choosingwiselycanada.org
Email: info@choosingwiselycanada.org
Twitter: @ChooseWiselyCA
Facebook: /ChoosingWiselyCanada

Easing Workload Burden

Overview

Time Needed to Treat

Time Needed to Treat Calculator

How to use the calculator ?

Examples in Practice