Primary care physicians (PCPs) do not have enough time in a day to provide comprehensive basic, guideline-based care, according to a simulation study.
PCPs require an “infeasible” 26.7 hours per day to provide preventive, chronic disease, and acute care to a typical American adult patient group, University of Chicago Justin Porter, MD, and colleagues, in in the Journal of General Internal Medicine .
The Porter team estimates that 26.7 hours per day will include:
- 14.1 hours of prevention Sexual Care
- Chronic Care 7.2 hours
- Acute Care 2.2 hours
- 3.2 hours for document and inbox management
“I think the results kind of confirm what the doctors have been anecdotal for a long time, which is that there is an unreasonable amount of work expected to be done,” Porter TellMedPage Today.
The authors looked at Hypothetical Panel and Nutrition Examination Survey (NHANES) data from 2,500 patients in National Health from 2017 to 2018 and measured “PCPs provide guideline recommendations to hypothetical patient panels” Average time required for preventive, chronic disease, and acute care in 2018. Estimates of time to access documents and time to manage electronic inboxes were also calculated. Time re-estimated in team-based care settings.”
In addition, they calculated the total annual hours per service according to the United States Preventive Services Task Force (USPSTF) guidelines, the studies on which the task force guidelines were based, and the original literature search “describe the frequency of their annual visits and the visits.”
The authors noted that their estimate of preventive care time, at 14.1 hours, was higher than that of 2003 American Journal of Public Health (AJPH) study (7.4 hours) and 2021 AJPH study (8.6 hours). The latter study actually tasked the USPSTF with declaring that “the time it takes to deliver recommended preventive care creates unrealistic expectations for already overwhelmed providers and puts patients at risk.”
But Porter and colleagues do offer a silver lining in this frustrating situation, reporting that using a team-based model in which non-PCPs (RNs and medical assistants) ) tants, for example) take on the care component, PCPs can reduce their working hours to 9.3 hours per day, and these time savings are primarily used for preventive care services and chronic care.
They found that in an “idealized” team-based model, non-PCP team members could partially or fully perform 29 preventive care tasks, leaving the PCP with about 2 per day hours of preventive care tasks. “Most of the time reduction was due to the 10.8-hour counseling assignment being transferred to a dietitian or counselor,” the authors wrote.
Co-author Neda Laiteerapong, MD, MS, University of Chicago, told MedPage Today that the team-based model “makes things happen Better…to go back to something like 9 or 10 hours [a day], which is a long time since the average primary care physician’s day was the last time this [type of study] was done in 2005.”
But a team approach “doesn’t solve all problems,” she warns.
Porter noted that some practices already incorporate elements of team-based care, such as nurses providing screenings for tobacco and alcohol use, possible domestic violence, or family health history prior to PCP arrival. “The reality is that every clinic we go to probably fits somewhere within that range,” he said.
The authors stress that unreasonable time requirements for PCPs are unique to the US healthcare system. : “If time pressure is driving the gap between guideline-based medicine and clinical medicine, this may explain why national health outcomes are worse than expected.”
Porter also noted that there are human There is a shortage of primary care, in part because PCPs are not paid as much as specialists. Also, in some cases, insurers do not reimburse many time-consuming recommended preventive services, such as diet and nutrition counseling, and may not happen at all at “gold standard” guidance levels.
“Medicare or Medicaid, usually private insurance, does not typically fund specific interventions unless done by a primary care provider,” Porter noted.
Porter said he hopes to use this research to reach out to policy makers to eventually increase PCP pay, better compensate non-PCPs, and shift from fee-for-service to based on Value care model.
“All of these things are very complex, very tricky, very challenging,” he said. “So while the problem is easy to identify, I think the solution is harder.”
Sophie Putka is a business and survey writer for MedPage today. Her work has appeared in The Wall Street Journal, Discover, Business Insider, Inverse, Cannabis Wire, and more. She joined MedPage Today in August 2021. focus on
Wave Special Disclosure has no relationship with the industry. Laiteerapong disclosed support from the National Institute of Diabetes and Digestive and Kidney Diseases.
A co-author disclosed support from the National Institute on Aging.