There’s been a lot of commentary on a recent article from the New England Journal of Medicine, detailing the undocumented tasks that a typical primary care physician performs.
For those who haven’t read the piece, entitled, What’s Keeping Us So Busy in Primary Care? A Snapshot from One Practice, it’s available free at the NEJM website. I highly recommend it.
To summarize, primary care doctors are responsible for much more than seeing patients in the exam room. In the cited practice, which has a fairly typical makeup, physicians were responsible for an average of over 23 telephone calls and 16 e-mails per day. Many practices don’t engage their patients over e-mail, so it’s conceivable that the number of telephone calls is lower than average here.
It’s interesting that this practice, until recently, employed no nurses (they hired one to do “information triage.”) Most use nurses do many of the calls, e-mails and outreach that the physicians here do. It’s also important to note that the doctors in the study were incentivized to communicate with patients outside the exam room, which is uncommon:
We have redefined “full-time physician” as one who offers 24 scheduled visit-hours per week, and our internal compensation system now recognizes telephone calls and e-mails as part of our productivity metric.
This piece quantifies the bureaucratic responsibilities that primary care doctors increasingly face. Many of these services are not valued by Medicare or most private insurers, who pay doctors based solely on face-to-face visits.
Consider that primary care practices are often run like small businesses, and most are not financially viable without help from an associated hospital or large health system. So for patients who wonder why it’s so difficult to communicate with their doctor, hopefully this study will starkly illustrate the uncompensated pressures they face.
*This blog post was originally published at KevinMD.com*