What’s Keeping Us So Busy in Primary Care? A Snapshot from One Practice

Published - Written by Karen Buckley

Dr. Richard Baron is one of five staff physicians in a community-based internal medicine practice in Philadelphia.  While productivity in such a practice is usually measured by number of visits, much more time is dedicated to non-visit work.  He and his colleagues used their electronic health record to count their units of primary care work over a year in order to provide a more detailed description of their workload.  They present the information this week in an Occasional Note.

In addition to the five physicians, their staff included four medical assistants, five front-desk staff, one business manager, one billing manager, one health educator (hired midyear), and two clerical staff.  In 2008, they had a caseload of 8440 patients.

In a typical day, each doctor saw 18 patients, made 24 telephone calls, sent 17 e-mail messages, and reviewed 31 laboratory and imaging reports and 14 consultation reports.

“This study gives us a picture of the typical day of primary care physicians and how much time they spend caring for patients before and after their scheduled visits with patients,” says NEJM deputy editor, Dr. Mary Beth Hamel.

On the basis of their analysis, the authors decided to hire a registered nurse to help triage lab reports, phone calls and consultation notes.  They also hired additional front-desk staff and medical assistants.

The authors conclude, “At a time when the primary care system is collapsing and U.S. medical-school graduates are avoiding the field, it is urgent that we understand the actual work of primary care and find ways to support it. Our snapshot reveals both the magnitude of the challenge and the need for radical change in practice design and payment structure.”

Is your typical day comparable to these Philadelphia physicians’?  What could be done to make handling your workload more efficient?