Study examines doctors' uncompensated daily work

The New York Times: "A new study detailing the uncompensated work burden on family doctors points to the need to change how they are paid, medical experts say — particularly as the new health care law promises to add millions more patients to the system. … Family doctors make up the embattled front line of the nation's health care system. They earn about half the money of specialists who focus on treating particular ailments or parts of the body. That is a reason less than 10 percent of medical school graduates choose so-called primary care, which includes general internists and pediatricians. Worsening shortages of family doctors were being predicted even before the recent health care legislation, which opened the door to an estimated 30 million newly insured people who will begin making appointments for checkups and other care. … Comparatively modest salaries and rising patient numbers are part of the challenge, medical experts say. But so is the breadth of the unpaid work performed by family doctors. A study published on Wednesday in the New England Journal of Medicine measured that problem precisely, using computerized patient records and reporting systems to track all the tasks done in a five-physician practice over a year" (Lohr, 4/28). 

The study is called "What's Keeping Us So Busy in Primary Care? A Snapshot from One Practice" (Baron, 4/29).

The Washington Post: "In addition to seeing patients, a primary-care physician each day must address more than three dozen urgent but uncompensated tasks, according to a study that provides a rare, quantitative look into the mechanics of office practice. Answering telephone calls and e-mail messages, refilling prescriptions, reviewing lab test results and consulting with other doctors consume large amounts of time each day, even though none of it is paid for, according to the study. Primary care is a centerpiece of the recently enacted health-care law, which provides incentives for doctors, nurses and physician assistants to enter the field. ... Primary care, however, is an increasingly unpopular field, and the new study sheds light on possible reasons." Research has only occasionally tried to measure office physicians' time pressures. "In general, they have painted a similar picture: days filled with short patient visits and dozens of just-in-time interruptions" (Brown, 4/29).

The Wall Street Journal Health Blog:  "[T]he analysis gives a peek into the 'invisible' work not involving a patient visit. Here's a breakdown of the metrics per doctor, per day: 23.7 telephone calls, most of which the doc handled directly; 16.8 emails, most for interpreting test results; 12.1 prescription refills, not including those part of a patient visit; 19.5 lab reports; 11.1 imaging reports; 13.9 consult reports; And that's on top of 18.1 patient visits" (Hobson, 4/28).

Reuters: Dr. Richard Baron, the study's author, "said his practice, like many U.S. practices, is paid via a patchwork of Medicaid, Medicare -- the U.S. government health insurance plans for the poor, disabled and elderly -- as well as private insurance. … Electronic health records have helped but his office still employs four medical assistants, five front-desk staff, a business manager, a billing manager, a health educator and two full-time clerical staff. … Currently doctors are usually reimbursed only for a patient visit, but Baron does not advocate being paid per phone call or per prescription. … Instead, how about an annual fee per patient, asks Baron" (Fox, 4/28). 

USA Today: "Though his practice cares for a socioeconomically diverse patient population of about 8,500 in Philadelphia's Mount Airy neighborhood, Baron says, 'I certainly believe the demands and the activities we describe in the article are absolutely typical' of all primary care practices" (Rubin, 4/28).