Primary care doctors would need more than 24 hours a day to provide recommended care – UChicago News

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If they followed national recommendation guidelines for preventive care, chronic disease care and acute care, it would take a primary care physician 26.7 hours a day to see an average number of patients, a new study finds.

“There’s this kind of disconnect between the care we’re trained to give and the constraints of a clinic workday,” said Justin Porter, lead author of the paper and an assistant professor of medicine at the University of Chicago. “We have an ever-increasing set of guidelines, but clinic slots have not increased proportionately.”

This study builds on others that have found a discrepancy between guidelines and a doctor’s time. And it has real implications for the delivery of health care; the researchers said that time pressure helps explain why improvements in outcomes have not kept pace with progress made in the field.

Time pressure plays a role in healthcare inequities, with vulnerable populations typically receiving care at overburdened clinics. It also affects patient satisfaction.

“When you survey patients about what frustrates them about their medical care, you’ll often hear, ‘My doctor doesn’t spend time with me,’ or ‘My doctor doesn’t follow up,'” Porter said. “I think that many 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.

According to the researchers, time constraints are also an important factor in doctor burnout, one of the drivers that pushes medical students off the field.

The new research – carried out by the University of Chicago, Johns Hopkins University and Imperial College London – used a simulation study to calculate time per patient based on data from the National Health and Nutrition Examination Survey.

It built on previous studies by including all types of care that a primary care physician provides – preventive, acute and chronic – as well as administrative tasks, and accounted for changes in the guidelines that have occurred since previous studies were published. It also used a different methodology, using real patient data from an annual national survey to calculate its results. The previous studies used hypothetical patient populations based on the US population.

“When you​​​​​​are dealing with real people, you have more complexity for the data. A person can have multiple morbidity, or several chronic diseases at the same time,” said Porter. “That patient would be treated differently than a hypothetical average patient. This leads to more comprehensive and accurate calculations.”

Team-based care

For an average number of patients, the simulation study broke down recommended requirements to 14.1 hours/day for preventive care, 7.2 hours/day for chronic disease care, 2.2 hours/day for acute care, and 3.2 hours/day day for documentation and mailbox management – far exceeding the hours available on any given day.

The authors suggested a partial solution in the form of a model called “team-based care,” in which nurses, physician assistants, counselors, and others help provide recommended care.

Their study found that team-based care reduced the time a physician needed to provide care from 26.7 hours/day to just 9.3 hours/day. The reduced workload breaks down into 2.0 hours/day for preventive care, 3.6 hours/day for chronic disease care, 1.1 hours/day for acute care, and 2.6 hours/day for documentation and mailbox management.

“Team-based care is a movement that has been around in medicine for a while and has been gathering steam more recently,” Porter said. “Doctors do not provide care in a vacuum. There are other extremely important members of the care team who work collaboratively and often independently to provide patient care. This is a huge opportunity and a partial solution to the time constraints currently faced in medical care.

The researchers used the Comprehensive Primary Care Plus (CPC+) model to develop the estimates for team-based care. The model allows doctors to focus on advanced care and brings in specialized medical professionals to take over other areas. For example, dieticians would handle nutritional advice for patients with diabetes or obesity, a time-intensive task. Overall, the researchers determined that 65% of primary care services could be handled by other team members.

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 illness. Still, the benefits of team-based care make it worthwhile, the researchers said.

Additional authors are Neda Laiteerapong with the University of Chicago; Cynthia Boyd of the Johns Hopkins School of Medicine; and M. Reza Skandari of the Imperial College Business School, London.

Citation: “Revisiting the time needed to provide primary care for adults.” Porter et al. Journal of General Internal Medicine1 July 2022.

– Adapted from an article first published by University of Chicago Medicine.

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