Doctors could save at least 30 minutes a day by not doing some clerical tasks and other functions that could be just as easily performed by other staff members, according to a study in Health Affairs. And that, say the authors, could fix our primary care shortage. It takes about 30 minutes to examine a patient, says the study “Expanding Primary Care Capacity by Reducing Waste and Improving the Efficiency of Care” in the November issue of Health Affairs. It adds up.
“If each of the 150,000–200,000 primary care providers currently practicing had one more visit on each of the 200 workdays in a year, that would be an additional 30 million to 40 million visits annually,” says the study.
Policy researchers estimate that full implementation of the Affordable Care Act would amount to as many as 24 million additional visits to primary care physicians (PCPs).
“Thus, independent of growth in the supply of primary care physicians [and] broad adoption of modest efforts to improve efficiency could lead to sufficient gains in workforce capacity to meet this additional demand,” says the study.
An effort to eliminate waste, the report asserts, would work better than the three ideas usually put forward to address the PCP shortage: train more, lose fewer, or find someone else, as the authors put it.
Train more: There may be more medical students, but that does not mean there will be more PCPs. “Even if a greater number of incoming medical students were attracted to careers in primary care, the positive effects on the workforce would not be realized for years because of how long training takes.”
Lose fewer: Many PCPs reduce their hours or leave practice entirely because of burnout. Physician organizations make outreach efforts but “they apply only to a relatively small number of physicians who are out of the workforce and seeking to return to practice.”
Find someone else: Physician assistants, nurses, and nurse practitioners should be able to do many primary care activities. “However, like physicians, more physician assistants and nurse practitioners are electing to enter subspecialty practices.”
One suggestion: PCPs need flow managers to guide “the physician’s activities throughout the workday with comments such as: ‘the patient is ready,’ ‘return this call,’ ‘take care of these tasks,’ and ‘sign this form.’”
It also helps when PCPs are not in their offices but in “flow stations” with other members of the staff. “HealthPartners, in Minnesota, determined that the use of flow stations can save 30 minutes of a physician’s time per day,” the study states.
It adds, “A medical education is a terrible thing to waste. The unique skills of the physician should be put to use not just a fraction of the time, but [most] of the time.”