It would take a primary care physician 26.7 hours per day to follow nationally recommended guidelines for preventative, chronic disease, and acute care for an average number of patients, research has shown.
That breaks down to 14.1 hours per day for preventive care, 7.2 hours per day for chronic disease care, 2.2 hours per day for acute care, and 3.2 hours per day for documentation and inbox management.
The research used a simulation study to compute time per patient based on data from the National Health and Nutrition Examination Survey.
“There is this sort of disconnect between the care we’ve been trained to give and the constraints of a clinic workday,” said Dr. Justin Porter, assistant professor of medicine at the University of Chicago and lead author of the paper. “We have an ever-increasing set of guidelines, but clinic slots have not increased proportionately.”
The study also looks at physician time as part of a team, where nurses, physician assistants, counselors, and others help to deliver recommended care.
It found that team-based care reduced the time a physician needed to deliver care to 9.3 hours per day, broken into 2 hours per day for preventive care, 3.6 hours per day for chronic disease care, 1.1 hours per day for acute care, and 2.6 hours per day for documentation and inbox management.
“Team-based care is a movement that has been around in medicine for a while and has gathered steam more recently,” Porter said. “Doctors do not give care in a vacuum. There are other extremely important members of the health care team that are working together and often independently to provide care for patients. This is a huge opportunity and partial solution to the time constraints currently faced in medical care.”
The study appears in the Journal of General Internal Medicine.
Real Patients and Hours in the Day
This new study builds on others that have found a discrepancy between guidelines and a physician’s time.
In 2003, a Duke University study estimated that it would take a primary care physician 7.4 hours per day to provide preventive care for an average-sized patient population, while a 2005 study from Mount Sinai Hospital found that it would take 8.6 hours per day. A complementary study from Duke in 2005 calculated an additional 10.6 hours per day to manage the top 10 chronic diseases. Together, that indicates that a doctor would need at least 18 hours per day to provide both preventive and chronic care.
The new study goes one step further by including all types of care that a primary care physician provides—preventive, acute, and chronic—as well as administrative tasks, and it accounted for changes to the guidelines that have occurred since the earlier studies were published. It also used a different methodology, employing real patient data from an annual national survey to calculate its results. The earlier studies used hypothetical patient populations based on the U.S. population.
“When you’re dealing with real people, you have more complexity to the data. A person may have multi-morbidity or several chronic diseases at once,” Porter said. “That patient would be treated differently than a hypothetical, average patient. This leads to more comprehensive and precise calculations.”
The study’s data on team-based care also expanded the information available on time constraints for primary care physicians.
The researchers used the Comprehensive Primary Care Plus (CPC-Plus) model to develop the estimates for team-based care. The model allows physicians to focus on advanced care and brings in specialized medical professionals to take over other areas. For instance, dietitians would handle nutritional counseling for patients with diabetes or obesity, a time-intensive task. Overall, the researchers determined that 65 percent of primary care services could be handled by other team members.
Time for More Team Care?
Moving to a team-care model would require systemic changes to the way Americans pay for care. Currently, payment for many counseling services depends on patients having a qualifying disease. Yet the benefits of team-based care make the effort worth it, the researchers said.
The time pressure that physicians face has real consequences for the delivery of health care. According to the researchers, time constraints are a key factor in physician burnout, one of the drivers pushing medical students from the field.
For patients, time pressure helps explain why improvements in outcomes haven’t kept pace with advances made in the field, the researchers said. It plays a role in inequities in health care, with vulnerable populations typically receiving care at overburdened clinics. It also has an impact on patient satisfaction.
“If you do surveys with patients about what frustrates them about their medical care, you’ll frequently hear, ‘My doctor doesn’t spend time with me’ or ‘My doctor doesn’t follow up,’” Porter said. “I think a lot of times, this is interpreted as a lack of empathy or a lack of willingness to care for a patient. But the reality—for the majority of doctors—is simply a lack of time.”
Additional coauthors for the study are from the University of Chicago; Johns Hopkins School of Medicine; and Imperial College Business School, London.