April 29, 2010
Primary-care physicians routinely perform dozens of daily tasks for which they are not paid, claims a new study, and a fairer compensation system must be implemented to attract more doctors to the specialty.
Dr. Richard Baron's study, "What's Keeping Us So Busy in Primary Care? A Snapshot from One Practice," published in the New England Journal of Medicine, details the number of uncompensated tasks primary-care doctors performed at a practice in Philadelphia during one year. The report notes that in 2008 each of the five physicians handled about 20 phone calls and 17 e-mails every day, on top of seeing an average of 18 patients daily. The doctors also wrote an average of 12 prescriptions, read 20 lab reports, and reviewed 14 specialist reports and 11 imaging reports (such as MRIs, CAT scans and X-rays) daily.
"Even though I've been doing this for 20 years, this is really a surprise," said Baron in an interview with USA Today. "I certainly believe the demands and the activities we describe in the article are absolutely typical" of all primary care practices, he added.
The report is particularly timely since the new federal healthcare legislation is expected to aggravate a nationwide primary-care physician shortage. The primary-care profession is decidedly unpopular, with the vast majority of medical school students opting to instead choose higher-paid medical specialties.
"At a time when the primary care system is collapsing and U.S. medical school graduates are avoiding the field, it is urgent that we understand the actual work of primary care and find ways to support," Baron writes in the study. "Our snapshot reveals both the magnitude of the challenge and the need for radical change in practice design and payment structure."
The New York Times reports that Dr. David Blumenthal, national coordinator for health information technology for the Obama administration, noted that Baron's study was "full of important lessons for primary care and the nation's health system."
In the report, Baron proposes a system called capitation, which would provide a lump sum per patient to help compensate for the extra time doctors spend performing unpaid tasks.
"The way you pay us," Baron noted in USA Today as a message to healthcare policy makers and payers, "doesn't work for the work we actually need to do."
Compiled by Yaffa Klugerman
"Primary Care Internists Inundated with Phone Calls, E-Mails," USA Today, April 29, 2010, Rita Rubin
"Study Shows 'Invisible' Burden of Family Doctors," The New York Times, April 28, 2010, Steve Lohr
"What's Keeping Us So Busy in Primary Care? A Snapshot from One Practice," New England Journal of Medicine, April 2010, Richard J. Baron, M.D