How much time does it take for a primary care clinician to implement applicable guidelines for prevention and care in a typical practice?
Well, it’s good to know that a typical primary care clinician with a typical patient panel on a typical day can provide all necessary preventive care and acute and chronic illness care. Yeah, I’m kidding: The true estimate, if all boxes were ticked and all problems were completely addressed for all patients, is 26.7 hours a day, including 3.2 hours each day to care for and feed the electronic medical record monster. Using team-based care helps, but at an average 9.3 hours per day, don’t expect to eat lunch or get home on time for dinner. Some pundits have asked guideline developers to consider the “time needed to treat” when formulating their advice. 5
These authors conducted a theoretical modeling study to estimate the time needed to provide all the preventive care, chronic care, and acute care according to current guidelines. To estimate the time burden on a typical primary care practice, they created 1000 hypothetical primary care panels of 2500 patients. They identified all the Grade A and Grade B preventive care guidelines for adults from the United States Preventive Services Task Force and the Advisory Committee on Immunization Practices of the Centers for Disease Control (N = 48). The authors picked guidelines for the top 10 chronic illnesses and calculated the average number and length of visits for acute illness among adults. They estimated the time with and without team-based care. The complete basket of services was estimated to require 26.7 hours per day, which includes 3.2 hours each day for documentation and inbox management, 14.1 hours for preventive care, 7.2 hours for chronic disease care, and 3.2 hours a day for acute care. Panel size affects work: Decreasing to a panel size of 1500 patients decreases physician time by 10.7 hours and increasing to 3000 patients increases time by 5.3 hours. Estimates for practices using high-functioning teams are lower: 9.3 hours per day of clinician time, which includes 2.6 hours per day for and inbox management. These estimates don’t likely apply to countries with healthcare systems that aren’t driven by insurance companies and their documentation requirements.
Allen F. Shaughnessy, PharmD, MMedEd
Professor of Family Medicine