What with increased pressure on primary care doctors to be efficient and a more than 10% drop in their pay in the last decade (when accounting for inflation), you might imagine that the time they spend with each patient would have shortened also. Patients often complain so.
But this hasn't happened, according to a new report. (We can't speak for time spent in the waiting room flicking through four-week-old copies of Sports Illustrated. The studies didn't look at that.)
Between 1997 and 2005, based on a nationally representative sample of adult patients, the average visit with a primary care doctor increased from 18 minutes to nearly 21, Dr. Lena M. Chen and other Massachusetts researchers reported in the journal Archives of Internal Medicine. Face time, we're talking. Not waiting-shivering-in-paper-robe time.
"We found no evidence that primary care physicians, despite decreasing income and increasing pressures for greater efficiency, have responded by shortening the time they spend with their patients," the authors wrote. "In fact, primary care physicians spent 16% more time during a typical office visit in 2005 compared with 1997."
The researchers did find that doctors spent more time with older patients -- not surprising, since older people generally have more health issues. This could be part of the reason why visits to doctors are increasing in average length -- because the general population is becoming older and sicker. But it's not the whole reason. The researchers say it may also be because the health in the adult population is more complicated than it was (we do have spiraling rates of diabetes, for example). And these days, patients are more involved the decision-making process over their care than they were in the days of "Doctor Knows Best."
The researchers also found that the doctors spent less time with racial/ethnic minority groups. Although they do not know the reason for this, "our findings may explain why patients of minority groups do not always receive care that is comparable to that provided to white patients," they write.
Did the extra time with physicians result in better quality of care? Not for the prescribing of drugs, the researchers found. However, in cases where counseling or disease-screening was needed, there was a detectable improvement.
Not for everything, however: "We found no improvement in rates of diet and exercise counseling during the study period, despite evidence of the benefits of these interventions among high-risk patients," the authors wrote.
And, they add, three's plenty of room for improvement -- which, they add, probably will entail wider use of electronic medical records, more use of nurse practitioners for aspects of care, and increased pay for doctors.
-- Rosie Mestel