A new study by Tai-Seale, McGuire, and Zhang (HSR 2007) analyzes how primary care physicians allocate their time in a typical office visit. The authors use data from 392 videotaped office visits conducted in three settings: 1) a salaried group practice in an academic medical center (AMC), 2) a managed care group (MCG), and a fee-for-service inner city solo (ICS) practitioners with an Independent Practice Association contract. The authors found that the average length of a visit was 17.4 minutes but the median visit length was only 15.7 minutes.
|Median visit Length||15.7||23.3||13.4||9.7|
|Median time spent on Major topic||5.3||6.7||4.8||3.2|
|Median time spent on Minor topic||1.1||1.4||0.9||0.7|
The data above show that only about 5 minutes was spent on discussing the major issue facing the patient. For minor issues, the doctor and patient only spent one minute discussing the issue. We see that physicians at the AMC spent the most time with their patient while the physicians at the ICS spent the least. The authors find that “…while time spent by the patient and physician on a topic responds to many factors, time of the visit overall is much less malleable.”
The paper also notes that “[i]ncentives in prevailing physician payments favor procedure-based patient care over time-intensive evaluation and management care.” One could easily imagine a system with a flexible physician schedule. The patient could schedule a standard 15 minute appointment for the usual co-pay, or could pay the physician extra if they wanted a 20 minute, 30 minute or 1 hour appointment. This way, the physician would be reimbursed for their time. If the insurance company paid for these extra minutes, the physicians would have an incentive to exaggerate the number of minutes spent on each patient. Thus, a likely solution is for the insurance company to pay for the base appointment length (15 minutes) and anything over this the patient will have to pay for.
- Tai-Seale M, McGuire TG, Zhang, W (2007) “Time Allocation in Primary Care Office Visits” HSR vol 42(5), pp. 1871-1894.