How Much Time Do Physicians Spend Providing Care Outside of Office Visits?

20 November 2007 | Volume 147 Issue 10 | Pages 693-698

Background: People with chronic illness require care outside of office visits, much of which is not reimbursed under current Medicare guidelines.

Objective: To describe the amount of time geriatricians spend and the nature of care they provide outside of office visits.

Design: Cross-sectional study on the time spent by physicians in clinical interactions outside of patient visits during 3 randomly sampled, 1-week periods.

Setting: An academic geriatric medicine ambulatory practice.

Participants: 16 physicians.

Measurements: Information on the method, content, outcome, and participants in clinical interactions outside of office visits was collected on a structured form.

Results: There were 472 discrete interactions, representing 296 episodes of care for 226 patients. Fifty-four percent of interactions were linked as multistep episodes, whose mean duration (range; 25th, 75th percentiles) was 18.9 minutes (3 to 70 minutes; 9, 21 minutes). Thirty-six percent of episodes involving a new medical symptom resulted in medication use, 27% resulted in an office visit, and 9% resulted in a referral to another physician. Mean time spent per physician per week was 112.2 minutes (range, 36 to 260 minutes), which represents an additional 6.7 minutes (range, 1.7 to 13.8) of care provided outside of office visits for every 30 minutes of time spent scheduled to see ambulatory patients. For a full-time physician scheduled to see 14 patients per day in 30-minute visits over a 5-day workweek, this would represent an extra 7.8 hours of clinical work per week.

Limitation: Data were self-reported and were limited to an academic geriatric medicine practice.

Conclusion: Physicians spend a considerable amount of time providing care outside of office visits for patients with chronic illness. This study suggests that collecting empirical data on the amount and nature of nonreimbursed care activities is feasible and should be done in more generalizable settings to inform debates about reimbursement reform.

Editors' Notes Context Much of primary care takes place outside of office visits and is not reimbursed. Contribution By using the information recorded by physicians in an academic geriatrics practice, the authors estimate that providers spent an additional 6.7 minutes providing care outside of every 30-minute office visit, which amounted to an estimated extra 7.8 hours of clinical work per week for a full-time provider. Caution The findings may not be generalizable to full-time clinicians in community practices. Implication Providers spend a lot of unreimbursed time outside of office visits providing care. The time can be quantified, and similar data should be collected in broader settings to inform debates over reimbursement reform. —The Editors

 

Author and Article Information

From Mount Sinai School of Medicine, New York, and Bronx Veterans Affairs Medical Center, Bronx, New York.

Grant Support: Dr. Siu is the recipient of a Midcareer Investigator Award in patient-oriented research from the National Institute on Aging.

Potential Financial Conflicts of Interest: None disclosed.

Requests for Single Reprints: Jeffrey Farber, MD, Mount Sinai School of Medicine, One Gustave L. Levy Place, Box 1070, New York, NY 10029-6574; e-mail, jeffrey.farber{at}mssm.edu.

Current Author Addresses: Drs. Farber and Bloom: Mount Sinai School of Medicine, One Gustave L. Levy Place, Box 1070, New York, NY 10029-6574.

Dr. Siu: Bronx Veterans Affairs Medical Center, 130 West Kingsbridge Road, Bronx, NY 10468.

Author Contributions: Conception and design: J. Farber, A. Siu, P. Bloom.

Analysis and interpretation of the data: J. Farber, A. Siu.

Drafting of the article: J. Farber, A. Siu, P. Bloom.

Critical revision of the article for important intellectual content: J. Farber, A. Siu.

Final approval of the article: J. Farber, A. Siu, P. Bloom.

Provision of study materials or patients: J. Farber, P. Bloom.

Collection and assembly of data: J. Farber.