Work effort and time expenditure of primary care physicians

1. In this cross-sectional study, primary care physicians were estimated to spend over sixty hours per week managing a full-time patient panel.

2. Factors associated with increased time per patient included part-time work, higher patient complexity, percentage of Medicaid patients, and medical advice request volume.

Evidence Rating Level: 3 (Average)

Study Rundown: Recent decades have seen an expansion in primary care work, from managing medical conditions and coordinating with specialists to answering asynchronous messages from patients. Knowledge of the time involved in managing primary care panels is necessary to improve the sustainability of primary care work and address impending workforce shortages. This study aimed to estimate the work effort per patient done by a full-time primary care physician (PCP) every year as well as clinician and patient factors affecting time expenditure. Based on electronic health record (EHR) and administrative data, the median calculated yearly work effort per patient was estimated to be over one hour. This number increased to over one and a half hours per patient when time not captured by administrative or EHR data was included. Both median yearly work effort per patient and median yearly work effort per one clinical full-time equivalent (cFTE) increased with less clinical workload. Other factors associated with increased yearly time per patient included higher Elixhauser comorbidity score, average patient age, percentage of Medicaid patients, and average number of medical advice request messages per patient per year. Practicing in a community health center was associated with significantly less yearly time per patient. The generalizability of this study is limited by its focus on a single well-resourced integrated health system in the Northeast, as well as by a lack of information on specific practice structures or supports available to PCPs. Nevertheless, these results characterize the average PCP workload required to maintain a clinical full-time patient panel and highlight factors influencing time expenditure.

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Relevant Reading: Revisiting the Time Needed to Provide Adult Primary Care

In-Depth [cross-sectional study]: This cross-sectional study aimed to estimate the average amount of time that a PCP spent on each patient per year and what factors, including clinical workload, may affect this amount. Data were obtained from electronic health record activity log data from 2021 for attending PCPs (including family medicine and internal medicine physicians) working at 33 clinics in the Mass General Brigham health system. The study included PCPs who delivered patient visits for at least 9 months in the year. The study included 406 PCPs, 62.3% (n = 253) of whom were female and 31.3% (n = 127) of whom had a cFTE of less than 0.5. In all, PCPs saw a median of 110.2 appointments (interquartile range [IQR], 67.1 to 150.4 appointments) and received 134.0 messages (IQR, 83.3 to 190.6 messages) per month. The PCPs had a median of 944 patients (IQR, 567 to 1358 patients) in their panels, or 1668 patients (IQR, 1432 to 1883 patients) per 1.0 cFTE. A median of 67.6% (IQR, 37.6% to 77.8%) of panel patients were female and 7.3% (IQR, 4.5% to 13.1%) had Medicaid insurance; the average panel had a median age of 53.0 years (IQR, 47.7 to 58.0 years) and Elixhauser score of 1.4 (IQR, 1.0 to 1.9). The median calculated yearly work effort per patient based on EHR and administrative data was 1.3 hours (IQR, 1.0 to 1.6 hours), corresponding to 45.1 hours (IQR, 36.9 to 55.2 hours) per week for a 1.0-cFTE physician working 46 weeks a year. When accounting for time not captured by EHR and administrative data, the median calculated yearly work effort per patient expanded to 1.7 hours (IQR, 1.4 to 2.2 hours), corresponding to a median yearly work effort per 1.0 cFTE of 2844.3 hours (IQR, 2324.9 to 3478.9 hours), or 61.8 hours (IQR, 50.5 to 75.6 hours) per week. Predicted differences in yearly time per patient associated with having a panel in the 75th versus the 25th percentile were 8.3 minutes (IQR, 0.8 to 15.8 minutes) for average Elixhauser score, 8.3 minutes (IQR, 4.3 to 12.2 minutes) for percentage of Medicaid patients, 8.5 minutes (IQR, 1.2 to 15.7 minutes) for average age, and 27.7 minutes (IQR, 16.8 to 38.5 minutes) for average yearly medical advice request messages per patient. Practicing in a community health center was associated with significantly less yearly time expenditure per patient when this factor was added to the model. Overall, this study suggests that full-time PCPs work over sixty hours per week, with time expenditure affected by factors including disease burden, age, and Medicaid status.

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