Recommendations for care outpace the time available for a typical primary care practice

Reference

Porter J, Boyd C, Skandari MR, Laiteerapong N. Revisiting the time needed to provide adult primary care. J Gen Intern Med 2023;38(1):147-155.

Synopsis

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.