Last year, we reported a downward trend in physician productivity during the first five years of the new century. While the number of hours doctors are putting in at the office seems to have stabilized in all but a few of the specialties we survey—and gone up for four—it's not necessarily because patients are clamoring to be seen. According to the most recent Medical Economics Continuing Survey, physicians in many specialties reported working as many hours this year as they worked in 2005—or more—while seeing fewer patients.
Indeed, among all primary care physicians, the median workweek remained at 50 hours in 2006, but doctors reported a median 104 patient visits per week this year as compared to 110 last year. FPs, who held steady at 50-hour workweeks in 2005 and 2006, went from seeing 120 patients each week to seeing 109. Pediatricians are still working a median 45 hours a week, but they're seeing just 108 patients, down from 121.
In an even more dramatic indication of this trend, GPs reported longer workweeks—50 hours per week in 2006, up from 45 hours last year—while seeing fewer patients (108 a week in 2005; 100 in 2006). Internists are the only primary care group that reported a median drop in both workweek (from 55 to 50) and patient visits (from 109 to 100).
Gastroenterologists and infectious disease specialists reported drops in workweeks and patients seen from last year to this year. But they're the exception. Many specialists say they're spending as many or more hours at work in the service of fewer patients. Allergists/allergy immunologists went from 40-hour workweeks to 45 hours, while seeing 70 patients a week—down from 80 in 2005. Endocrinologists added five hours to their median workweek (from 55 to 60) while seeing some 80 patients a week—down from 100 in 2005. Orthopedic surgeons saw 102 patients per week in 2005 and 96 patients in 2006, but put in a median of eight more work hours—58 instead of 50. Rheumatologists and urologists maintained the same number of work hours but saw fewer patients.
What's going on here? It's the paperwork, say practice management consultants. One, Ginny Martin of Health Care Consulting Associates of Northwest Ohio in Waterville, attributes the longer hours to the steady rise in coding documentation requirements and the need for more physician involvement in the administrative side of running an office. Another explanation, she points out, is the aging population. Patients are presenting with more complex medical histories and problems, requiring additional physician time.
Also, doctors who are switching from manual record-keeping to EHRs might find that they have to put in more office hours to get the new system up and running. "We've seen EHR implementation dig deeply into physician productivity until the practice members are adept at using the system," says Judy Bee of Practice Performance Group in Long Beach, CA.
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