In a new study published in the Journal of General Internal Medicine, researchers found that in order to provide guideline-recommended care, a primary care physician would require nearly 26.7 hours per day.
The study was pioneered by Dr. Justin Porter, M.D., at the University of Chicago School of Medicine, and is titled “Revisiting the Time Needed to Provide Adult Primary Care.” The study looked at a hypothetical panel of 2500 patients, and what it would take to provide them guideline directed care (e.g. per The US Preventative Services Task Force guidelines). The studied categories included preventative care, in addition to chronic disease and acute care.
The results were jarring, indicating that there are literally not enough hours in the day for physicians to abide by all the recommendations that have been stipulated for “ideal patient care,” especially with the significant time challenges that actually exist in a real practice setting.
Dr. Porter explains: “There is this sort of disconnect between the care we’ve been trained to give and the constraints of a clinic workday […] We have an ever-increasing set of guidelines, but clinic slots have not increased proportionately.”
The practice of medicine is very different from the theoretical delivery of it. In real time practice, physicians are often bogged down with numerous tasks and inefficiencies that constantly distract their workflow. One of the biggest time investments is charting. For years, electronic health record (EHR) systems promised to hasten the charting process, providing physicians with the digital tools required to chart faster and more efficiently. However, many physicians often find these EHR systems more cumbersome than traditional written charts, forcing them to spend more time troubleshooting complex systems than with actual patients.
And there are so many other things that a physician has to do during a workday—deal with insurance matters, call patients back about results, deal with patient queries, work with auxiliary staff on practice management, etc. The list is ever-growing. Ultimately, the party that suffers the most is the patient.
Porter perfectly captures how patients feel about this conundrum: “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 […] 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.”
This has become a crucial problem in care delivery in nearly every context. In most parts of the country (and world), there is a massive physician shortage. This means that the physicians that are practicing have incredibly long patient rosters on a daily basis, and even longer waiting lists. Additionally, this is in the context of ever-growing pressure on physicians to increase their responsibilities, abide by new guidelines, and continue to maintain high patient satisfaction scores. Simply put, it is a never ending battle.
Undoubtedly, healthcare organizations and policy leaders must recognize these issues and take measures to alleviate some of these pressures. Whether that is funding more access to care opportunities or providing practices with more resources, change has to be enacted before this crisis leads to a point of no recovery.