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Lighten Your Workload

Less unnecessary care. More time for what counts.

Primary care practices across the country face significant workload challenges. Reducing low-value tests and treatments—those that provide little or no benefit—is an opportunity to ease this burden while improving patient care.

For patients, overuse can limit access to evidence-informed, personalized care. It shifts focus away from prevention, weakens the patient-physician relationship, and increases emotional, financial, and safety risks.

For clinicians, overuse adds unnecessary workload, limits time for appropriate care, and contributes to burnout.

For society, overuse strains the sustainability of our publicly funded health system and harms planetary health.

Examples

Don’t order Dual-Energy X-ray Absorptiometry (DEXA) screening for osteoporosis in low-risk patients. Use “risk-assessment first” screening before ordering DEXA.
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Time saved: A risk-assessment first screening approach with FRAX for women 65 years and over saves at least 150 hours over 25 years, 6 hours per year, or 30 minutes per month, compared to DEXA screening first. This evidence-based approach respects the patient’s values and preferences and requires the least amount of clinician time.
Don’t do imaging for lower back pain unless red flags are present.
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Time saved: Imaging of the lower spin before six weeks does not improve outcomes. A tailored approach to lower back pain that respects the evidence about the time before imaging and the absence of red flags saves 1 hour per month, 1 day per year and 5 weeks in a career. Such an approach decreases the potential for medicalization and thus potential harm to patients.
Don’t do annual screening blood tests unless directly indicated by the risk profile of the patient.
3

Time saved: Refraining from ordering a CBC when there is no clinical basis to do so respects the evidence and saves 1,5 hours per month, 2 days per year and 8 weeks over a career. Such an approach decreases medicalization and potential harm to patients.

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

The “Time Needed to Treat” (TNT) concept emphasizes the importance of considering clinician time as a finite resource that needs careful prioritization in clinical practice. It was developed by Dr. Minna Johansson, Dr. Gordon Guyatt and Dr. Victor Montori.

Use the Time Needed to Treat Calculator to reflect on the time spent on low-value practices. It may help you choose a less time-consuming approach when the benefits are similar between different options.

Time needed to treat calculator

Time needed to treat calculator
Introduction

“There is a significant gap between the expectations placed on healthcare professionals and the time they have to provide the expected care. This massive gap contributes to inefficiency in healthcare because we do not dedicate time to the most beneficial interventions. It also contributes to inequality in healthcare because we do not devote our time to patients who need care the most. Finally, it is a source of moral stress, moral injury, and professional burnout among clinicians.”

- Minna Johansson

Family Physician

Founder of the Cochrane Sustainable Healthcare Initiative

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All clinical actions require time, and the purpose of the calculator is not to question well-established medical practices with proven benefits. The calculator is designed to help you reflect on the time spent on low-value practices or to choose a less time-consuming approach when the benefits are similar between several options.

Visit the Global Center for Sustainable Healthcare's website for more information.
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.
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Time to Treat Calculator

Time needed to treat calculator

How to use the calculator ?

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