Is there an optimal number of patients that primary care physicians should care for?
Turns out there isn’t enough evidence to draw any conclusions, according to a new study published in the Annals of Internal Medicine.
After reviewing 28 studies that looked at primary care patient load and the effect on health outcomes and provider burnout, researchers concluded that there is insufficient evidence to make any evidence-based recommendations about the optimal number of patients that doctors should see to achieve beneficial health outcomes.
"Our principal finding is that the evidence about the association between panel size and aims of healthcare is surprisingly thin, given the importance of primary care panel size to all models of population-based care," the study found.
Patient load varies considerably for primary care providers, from less than 1,000 to more than 4,000 patients, the study said.
For physicians, a larger number of patients can mean less time to spend with each individual. For patients, it can translate to longer wait times for an appointment.
The researchers from the West Los Angeles Veterans Affairs Medical Center reviewed 16 hypothesis-testing studies and 12 simulation modeling studies that looked at the association of panel size with six major aims of quality healthcare and physician burnout.
“The few available studies provide a signal that increasing panel size may be associated with modest worsening of clinical quality and patient experience,” they said.
The researchers point out that current recommendations about panel size are based more on historical experience than on evidence.
In an accompanying editorial, the authors ask if the right question is to try to determine optimal panel size.
"Rather than asking, 'What is the ideal panel size in primary care?' we suggest reframing the question to 'What is the ideal practice model that results in the best outcomes for the entire U.S. population?' We believe that a well-trained, well-resourced primary care team will make the most of society's investment in these physicians' training and will contribute to better experiences for patients and clinicians, lower costs and better access to care," wrote Christine A. Sinsky, M.D., and Marie T. Brown, M.D., of the American Medical Association.