It's been well established that primary care physicians are stretched thin in meeting the healthcare needs of all of their patients. In fact, research has shown that it could take a primary care physician nearly 22 hours per day to provide all recommended acute, chronic and preventive care for a panel of 2,500 patients, according to a team of California-based researchers.
Faced with this impossible task, the team wrote in a study in the Annals of Family Medicine, physicians generally have two choices. The first option, which more physicians are giving a second look to, is adopting a concierge model, in which a doctor slashes his or her patient panel to provide remaining members full, comprehensive care. Concierge doctors make up for the lack in volume by charging patients a membership fee to receive special services. One major downside, however, is that this trend further strains an already shrinking pool of primary care physicians, effectively making the shortage worse.
The other alternative, and a cornerstone of the Affordable Care Act, is to increase the use of team-based models of care, under which all clinicians, such as nurse practitioners and physician assistants, work to the full extent of their licenses and leave the most serious and acute cases to physicians. In theory, these models allow doctors' bulging patient panels to still receive the bulk of their recommended care.
According to the researchers' calculations, up to 77 percent of primary care physician time usually spent on preventive care could be delegated. As for chronic care, the team estimated that physicians could delegate 75 percent of their time for patients in good control and 33 percent for patients in poor control.
Under this aggressive delegation model, which assumes that nonclinicians can provide large portions of routine chronic care services involving patient education, behavior-change counseling, medication adherence counseling and protocol-based services delivered under standing physician orders, the researchers concluded that one physician could reasonably care for a panel of 1,947 patients. The least-ambitious delegation model analyzed by the researchers, which delegated half of physicians' preventive care time and a quarter of all chronic care time, resulted in a panel size of 1,387.
Although the study provides a rough idea of how far primary care practices can extend their capabilities under team-based models, the authors acknowledged a number of limitations, noting that the research did not account for different types of patient mix. In addition, the study did not address how delegation affects the building of therapeutic relationships between patients and physicians.
To learn more:
- read the study from the Annals of Family Medicine