Team-based care would cut physician time, but would require systemic change, study says.
Primary care physicians would need more than 26 hours a day to have enough time for preventive care, chronic disease care, acute care, and administrative duties for their patients.
However, team-based care with nurses, physician assistants and counselors could cut that time to 9.3 hours a day, according to a new study that examined physician time and national guidelines for patient care.
“There is this sort of disconnect between the care we’ve been trained to give and the constraints of a clinic workday,” Justin Porter, MD, said in a news release. An assistant professor of medicine at the University of Chicago, Porter is lead author of “Revisiting the Time Needed to Provide Adult Primary Care,” published in the Journal of General Internal Medicine.
“We have an ever-increasing set of guidelines, but clinic slots have not increased proportionately,” he said.
The study revisited an issue that emerged in three 2005 studies that estimated primary care physicians would need at least 18 hours a day to provide preventive and chronic care. The new research combined all types of care that primary care physicians provide, with updated treatment guidelines and real patient data from an annual patient survey.
“When you're dealing with real people, you have more complexity to the data. A person may have multi-morbidity, or several chronic diseases at once,” Porter said in the news release. “That patient would be treated differently than a hypothetical, average patient. This leads to more comprehensive and precise calculations.”
Researchers found primary care physicians need 26.7 hours a day:
When researchers used the Comprehensive Primary Care Plus (CPC+) model to develop estimates for team-based care, they estimated up to 65% of primary care services could be handled by other specialized medical staff, while physicians would focus on advanced care. For example, dietitians could handle nutritional counseling for patients with diabetes or obesity.
With that arrangement, primary care physicians would spend:
The researchers note “moving to a team-care model would require systemic changes to the way Americans pay for care,” because current payment for many counseling services depends on patients having a qualifying disease.
But the benefits would be worth it, the researchers said, because time constraints are a key contributor toward physician burnout. Patients’ health and satisfaction would benefit through more time with physicians.
“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,’” Porter said. “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.”