The authors of the study wanted to know how long it would take a Principal Care Provider (PCP) to treat an average number of patients while following all recommended national healthcare guidelines. According to the article, “The researchers calculated how much time physicians would need each day to handle preventive care, chronic disease care and acute care as well as administrative tasks like documentation and inbox management.” The answer? Nearly 27 hours a day!
“It turns out that there are literally not enough hours in the day for doctors to do their best work,” states the Fierce Healthcare article. If you’ve ever suspected as much, now you have it in writing.
In the words of one of the study’s authors, quoted in a UChicago article2:
“There is this sort of disconnect between the care we’ve been trained to give and the constraints of a clinic workday,” said Justin Porter, M.D., assistant professor of medicine at the University of Chicago and lead author of the paper. “We have an ever-increasing set of guidelines, but clinic slots have not increased proportionately."
Specifically, the study found that PCPs need 26.7 hours per day to follow national recommended guidelines. This breaks down to 14.1 hours/day for preventive care, 7.2 for chronic disease care and 2.2 for acute care, with the remainder spent on documentation and inbox management.
This study builds on earlier work by Duke University that likewise found discrepancies between guidelines and a physician’s time. A 2003 Duke study3 found that providing the recommended preventive maintenance for patients would take an estimated 7.4 hours out of a primary care physician's day, leaving approximately 30 minutes for critical and chronic disease care.
Another Duke study4 in 2005 specifically asked, “Is there time for management of patients with chronic diseases in primary care?” That study determined that PCPs would need an additional 10.6 hours per workday to manage the top 10 chronic diseases among their patients. (The recent study by Porter et al took into account changes in guidelines since the Duke studies.)
Besides its impact on chronic and acute disease care, this conundrum has real consequences for the delivery of healthcare overall. According to the Fierce Healthcare article, “The researchers said that time pressure helps explain why improvements in outcomes have not kept pace with advances made in the field.”
“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,’” said Porter in the UChicago article. “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.”
Besides its obvious impact on care quality, this time pressure is also a factor in the increasingly important issue of care equity, as we covered in a previous blog,5 with vulnerable populations likely to receive care at already-overburdened neighborhood clinics.
What is the solution? How can an extra 10 hours be added to an already-overworked PCP’s day?
Per the Fierce Healthcare article, “The authors [of the study] suggested ‘team-based care,’ where nurses, physician assistants, counselors and others help to deliver recommended care, as one solution to the problem of overworked, burned-out primary care docs. Using team-based care, they estimated that primary care physician time could decrease to 9.3 hours per day.” [emphasis ours]
Is team-based care the solution, particularly for delivering higher quality chronic kidney disease (CKD) and end-stage renal disease (ESRD) care? Practices, providers and patients engaged in Healthmap Solutions (Healthmap) already know the answer to that: YES.
From its inception, team-based care has been central to the Healthmap program. By employing multidisciplinary teams of practice- and patient-facing advisors, we can extend the primary care practice’s capabilities beyond its four walls. Our intention is to provide the information, education, and follow-up that PCPs and their staff simply don’t have the time to offer. Our superior data analytics programs also allow for early detection of persons at-risk for CKD, enabling physicians to get ahead of their patients’ disease progression.
This approach has proven especially beneficial when managing patients with CKD Stage 3 and Stage 4, where these patients have not yet been referred to a Nephrologist and thus rely on the PCP for primary CKD management.
We invite you to review the articles cited above, then contact us to learn how Healthmap can help your PCPs offer more complete, thoroughgoing care for patient-members with CKD. And perhaps keep their sanity.