Part-time Physicians: Physician Workload and Patient-Based Assessments of Primary Care Performance

Murray, Alison; Safran, Dana Gelb; Rogers, William H.; Inui, Thomas S.; Chang, Hong; Montgomery, Jana E.

doi:10.1001/archfami.9.4.327

Cited by 43 publications

(59 citation statements)

References 17 publications

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“…Participants who worked less than 40 hours were designated part-time. 10 Part-time orientation was ascertained by soliciting attitudes about part-time jobs in medicine, including the consequences of working part-time on cooperation, teamwork, and intent to decrease hours. For this analysis, we included all Dutch respondents (n ϭ 1976) still practicing medicine.…”

Section: Methodsmentioning

confidence: 99%

Part-time medical practice: Where is it headed?

McMurray

Heiligers

Shugerman

et al. 2005

The American Journal of Medicine

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One of the fundamental tenets of medicine has been the centrality of the profession as a life calling; physicians work long hours and routinely sacrifice personal interests for professional demands. In 1993, only 13% of clinical faculty and 6% of basic science faculty members of U.S. medical schools worked part-time. 1 Historically, female physicians have been more likely than their male counterparts to work less than full time. Yet, despite increasing numbers of women in medicine and increased interest in personal time for self and family, U.S. medical workforce projections have forecast only a 3% decrease in the anticipated full-time equivalent of physicians over the next 10 years. 2 Trends in the general workforce provide a backdrop for changes in U.S. physicians' work hours. Over the past 20 years, full-time employment of women has increased 46%, while part-time employment has increased 88%. In 1988, women were 67% of the parttime labor force and 40% of the full-time labor force in the United States. 3,4 The percentage of women in the first year classes of U.S. medical students increased nationwide throughout the 1990s. These trends would indicate that an increase in interest in part-time work is likely to occur among U.S. physicians.The Netherlands has a health care system that includes prepaid and fee-for-service health care as well as Supported by grants from:

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Section: Methodsmentioning

confidence: 99%

Part-time medical practice: Where is it headed?

McMurray

Heiligers

Shugerman

et al. 2005

The American Journal of Medicine

View full text Add to dashboard Cite

show abstract

“…We found empirical evidence consistent with the argument that full-time physicians provide better access and continuity of care. [9][10][11][12]16 However, contrary to much of the The physician was the unit of analysis. The left out variables include: % 19≤Age<35, % Non-Hispanic White, % PPO, and the Division Two Indicator.…”

Section: Discussionmentioning

confidence: 99%

“…15 Despite these concerns, only one study included empirical evidence and found that PCPs working greater than 65 h/week had slightly higher continuity, but no difference in access. 16 Furthermore, the patient perspective on being cared for by a part-time PCP is not well understood. One systematic review concluded that provider work hours had no relationship with patient satisfaction, [16][17][18] yet because of the lack of welldesigned studies, the authors could not make strong conclusions about these findings.…”

Section: Introductionmentioning

confidence: 99%

“…16 Furthermore, the patient perspective on being cared for by a part-time PCP is not well understood. One systematic review concluded that provider work hours had no relationship with patient satisfaction, [16][17][18] yet because of the lack of welldesigned studies, the authors could not make strong conclusions about these findings. 13 However, there are several possible reasons why physicians with fewer clinical full time equivalents (FTEs) may have higher patient satisfaction scores.…”

Section: Introductionmentioning

confidence: 99%

“…21 There are several limitations with the current literature associating a physician's clinical work hours with patient satisfaction. A common limitation is the use of an arbitrary discrete cutoff to define part-time versus full-time, 16,17,21 with cutoffs ranging from 20 clinical hours/week 17 to 40 h/week of self-reported work. 16 No study has yet controlled for either continuity of care or access, which have both been associated with patient satisfaction, [28][29][30][31] or accounted for their potential mediating relationship, since continuity of care and access are also likely to be affected by a physician's work hours.…”

Section: Introductionmentioning

confidence: 99%

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Patients Report Better Satisfaction with Part-Time Primary Care Physicians, Despite Less Continuity of Care and Access

et al. 2014

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BACKGROUND:The growing number of primary care physicians (PCPs) reducing their clinical work hours has raised concerns about meeting the future demand for services and fulfilling the continuity and access mandates for patient-centered care. However, the patient's experience of care with part-time physicians is relatively unknown, and may be mediated by continuity and access to care outcomes. OBJECTIVE: We aimed to examine the relationships between a physicians' clinical full-time equivalent (FTE), continuity of care, access to care, and patient satisfaction with the physician. DESIGN: We used a multi-level structural equation estimation, with continuity and access modeled as mediators, for a cross-section in 2010. PARTICIPANTS: The study included family medicine (n=104) and internal medicine (n=101) physicians in a multi-specialty group practice, along with their patient satisfaction survey responses (n=12,688). MAIN MEASURES: Physician level FTE, continuity of care received by patients, continuity of care provided by physician, and a Press Ganey patient satisfaction with the physician score, on a 0-100 % scale, were measured. Access to care was measured as days to the third nextavailable appointment. KEY RESULTS: Physician FTE was directly associated with better continuity of care received (0.172 % per FTE, p<0.001), better continuity of care provided (0.108 % per FTE, p<0.001), and better access to care (−0.033 days per FTE, p<0.01), but worse patient satisfaction scores (−0.080 % per FTE, p=0.03). The continuity of care provided was a significant mediator (0.016 % per FTE, p<0.01) of the relationship between FTE and patient satisfaction; but overall, reduced clinical work hours were associated with better patient satisfaction (−0.053 % per FTE, p=0.03). CONCLUSIONS: These results suggest that PCPs who choose to work fewer clinical hours may have worse continuity and access, but they may provide a better patient experience. Physician workforce planning should consider these care attributes when considering the role of parttime PCPs in practice redesign efforts and initiatives to meet the demand for primary care services.KEY WORDS: part-time work; continuity of care; access to care; patient satisfaction.

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Part-time Training in General Surgery

et al. 2006

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The recent increase in female medical school enrollment and emphasis on lifestyle considerations for both men and women pose challenges for residency recruitment and retention. This study was designed to assess interest in part-time surgical training. We hypothesized that more women than men would be interested in this option. Design: A Web-based survey soliciting demographic information and opinions about training priorities was distributed to medical students, surgery residents, fellows, and trained surgeons. Respondents were asked to express on a 5-point Likert scale interest in (and deterrents to) substituting 1 or more years of standard residency with a shorter workweek (Ͻ 80 hours but Ͼ 40 hours) in exchange for a proportionately overall longer length of training. Setting: The survey was located on the American College of Surgeons Web site. Participants: Medical students (482), surgical residents (789), fellows (179), and fully trained surgeons (2858) affiliated with at least 1 of 4 major surgical societies. Results: There were 4308 respondents (76% male). Of physician respondents, 9.1% had taken time out of residency for nonresearch reasons. Thirty-six percent of female and 24% of male students agreed to increased interest in surgical careers if part-time training were an option (P=.005). Twenty-five percent of female and 13% of male residents (PϽ.001) expressed interest in this option. Prolonged training was cited as the primary deterrent. Conclusions: Eleven percent to 36% of total male and female respondents expressed interest in pursuing parttime training. Significantly more women than men favored a part-time option.

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Part-time Physicians: Physician Workload and Patient-Based Assessments of Primary Care Performance

Cited by 43 publications

References 17 publications

Part-time medical practice: Where is it headed?

Part-time medical practice: Where is it headed?

Patients Report Better Satisfaction with Part-Time Primary Care Physicians, Despite Less Continuity of Care and Access

Part-time Training in General Surgery

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