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

Panattoni, Laura; Stone, Ashley; Chung, Sukyung; Tai–Seale, Ming

doi:10.1007/s11606-014-3104-6

Cited by 35 publications

(41 citation statements)

References 42 publications

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“…4 Perhaps patient satisfaction is more strongly influenced by the negative impact of burnout than the positive impact of continuity.…”

Section: Why Physician Work Hours Are Decreasingmentioning

confidence: 99%

“…10 Although these physicians may have worse continuity and access, they appear to provide a better patient experience. 4 Perhaps patient satisfaction is more strongly influenced by the negative impact of burnout than the positive impact of continuity.…”

Section: Why Physician Work Hours Are Decreasingmentioning

confidence: 99%

“…Continuity and patient access to care naturally decline when physicians work fewer hours. 4 Continuity and access are particularly challenging in some residency teaching practices where faculty and residents may be in clinic only 1 or 2 half-days per week. …”

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confidence: 99%

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Continuity and Access in the Era of Part-Time Practice

2018

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The number of physicians seeing patients part time is growing, an evolution that challenges the primary care pillars of continuity and access. The growth of parttime practice is a response to burnout and to the pressures facing primary care physicians. Physicians who work fewer clinical hours and thereby reduce burnout are more satisfied with their careers, less likely to leave their jobs, and provide a better patient experience. Primary care practices can make a number of adjustments to optimize continuity and access in this era of part-time practice. Moreover, physicians who work fewer clinical hours are equally capable of fostering trusting relationships with patients as physicians seeing patients full time. Due to the growing number of physicians seeing patients part time, the road to the patient-centered medical home (PCMH) is taking a detour. A major section of National Committee for Quality Assurance (NCQA)'s 2017 PCMH standards is focuesed on patient-centered access and continuity of care. Yet the increasingly part-time nature of medical practice can be a roadblock to both access and continuity.In 2011, 22% of male physicians and 44% of female physicians worked less than full time, up from 7% and 29% in 2005. 1 This essay explores ways in which primary care can adjust to the era of part-time practice, seeking to optimize continuity and access and to preserve the trusting therapeutic relationships at the heart of medical practice. CONTINUITY AND ACCESSInterpersonal continuity (patients seeing the same clinician every time they seek care) is associated with greater patient and physician satisfaction, better chronic and preventive care, reduced hospitalization rates, and lower costs.2 The majority of patients want the same primary care physician to care for them over time. 3 In particular, elderly patients, parents of young children, those on Medicare and Medicaid, those with chronic conditions, and those with worse health status value continuity. Young healthy people, in contrast, may prioritize prompt access over continuity. People who value continuity are willing to wait to be seen by their regular physician. 3The increase in part-time practice is eroding both continuity of care and prompt access to care. Continuity and patient access to care naturally decline when physicians work fewer hours. 4 Continuity and access are particularly challenging in some residency teaching practices where faculty and residents may be in clinic only 1 or 2 half-days per week. 5 WHY PHYSICIAN WORK HOURS ARE DECREASINGThe growth of part-time practice is a response to evolving difficulties in the primary care environment. A full-time primary care physician-working independently of a team and with a typical panel of 2,500 patients-could spend an impossible 21.7 hours each day providing full-spectrum, highquality acute, chronic, and preventive care. 6 The electronic medical record has increased total work time while reducing time spent with patients, contributing to the growing prevalence of health professional burno...

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“…4 Perhaps patient satisfaction is more strongly influenced by the negative impact of burnout than the positive impact of continuity.…”

Section: Why Physician Work Hours Are Decreasingmentioning

confidence: 99%

Section: Why Physician Work Hours Are Decreasingmentioning

confidence: 99%

See 1 more Smart Citation

Continuity and Access in the Era of Part-Time Practice

2018

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“…We suspect this has something to do with the nature of the encounters: in internal medicine, patients select their providers and would switch if they did not like the provider; however, this may be different in the typically episodic nature of procedural specialties. While one prior finding did not find an association between specialty and patient experience scores, the study only included internal medicine and family medicine physicians 5. An additional study with broader ranges of specialties did find a difference between specialties 7.…”

Section: Discussionmentioning

confidence: 80%

“…The literature evaluating the link between physician factors and patient experience scores in the clinic setting is very limited but is concordant with our findings. A study of patient experience scores in a single multispecialty group practice of mostly primary care physicians found no association between gender and scores 5. Another study of exclusively rheumatology patients also found no association between scores and physician gender or training level 6.…”

Section: Discussionmentioning

confidence: 97%

Physician characteristics associated with patient experience scores: implications for adjusting public reporting of individual physician scores

et al. 2018

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Association Between Physician Part-time Clinical Work and Patient Outcomes

et al. 2021

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IMPORTANCE Despite the growing number of physicians who reduce clinical time owing to research, administrative work, and family responsibilities, the quality of care provided by these physicians remains unclear.OBJECTIVE To examine the association between the number of days worked clinically per year by physicians and patient mortality. DESIGN, SETTING, AND PARTICIPANTSThis cross-sectional analysis was completed on a 20% random sample of Medicare fee-for-service beneficiaries 65 years and older who were admitted to the hospital with an emergency medical condition and treated by a hospitalist in 2011 through 2016. Because hospitalists typically work in shifts, hospitalists' patients are plausibly quasirandomized to hospitalists based on the hospitalists' work schedules (natural experiment). The associations between hospitalists' number of days worked clinically per year and 30-day patient mortality and readmission rates were examined, adjusting for patient and physician characteristics and hospital fixed effects (effectively comparing physicians within the same hospital). Data analysis was conducted from July 1, 2020, to July 2, 2021.EXPOSURES Physicians' number of days worked clinically per year. MAIN OUTCOMES AND MEASURESThe primary outcome was 30-day patient mortality, and the secondary outcome was 30-day patient readmission. RESULTS Among 392 797 hospitalizations of patients treated by 19 170 hospitalists (7482 female [39.0%], 11 688 male [61.0%]; mean [SD] age, 41.1 [8.8] years), patients treated by physicians with more days worked clinically exhibited lower mortality. Adjusted 30-day mortality rates were 10.5% (reference), 10.0% (adjusted risk difference [aRD], −0.5%; 95% CI, −0.8% to −0.2%; P = .002), 9.5% (aRD, −0.9%; 95% CI, −1.2% to −0.6%; P < .001), and 9.6% (aRD, −0.9%; 95% CI, −1.2% to −0.6%; P < .001) for physicians in the first (bottom), second, third, and fourth (top) quartile of days worked clinically, respectively. Readmission rates were not associated with the numbers of days a physician worked clinically (adjusted 30-day readmissions for physicians in the bottom quartile of days worked clinically per year vs those in the top quartile, 15.3% vs 15.2%; aRD, −0.1%; 95% CI, −0.5% to 0.3%; P = .61). CONCLUSIONS AND RELEVANCEIn this cross-sectional study, hospitalized Medicare patients treated by physicians who worked more clinical days had lower 30-day mortality. Given that physicians with reduced clinical time must often balance clinical and nonclinical obligations, improved support by institutions may be necessary to maintain the clinical performance of these physicians.

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

Cited by 35 publications

References 42 publications

Continuity and Access in the Era of Part-Time Practice

Continuity and Access in the Era of Part-Time Practice

Physician characteristics associated with patient experience scores: implications for adjusting public reporting of individual physician scores

Association Between Physician Part-time Clinical Work and Patient Outcomes

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