Primary care docs need 27 hours a day to provide guideline-based care, study finds

It's already known that primary care doctors are overworked. It turns out that there are literally not enough hours in the day for doctors to do their best work.

Primary care clinicians need 26.7 hours per day to follow national recommended guidelines for preventive care, chronic disease care and acute care while seeing an average number of patients, according to a new simulation study

That breaks down to 14.1 hours a day for preventive care, 7.2 hours a day for chronic disease care, 2.2 hours a day for acute care, and 3.2 hours per day for documentation and inbox management.

The research, conducted by the University of Chicago, Johns Hopkins University and Imperial College London, used a simulation study to compute time per patient based on data from the National Health and Nutrition Examination Survey.

“There is this sort of disconnect between the care we’ve been trained to give and the constraints of a clinic workday,” said Justin Porter, M.D., assistant professor of medicine at the University of Chicago and lead author of the paper, according to a UChicago article about the study.

“We have an ever-increasing set of guidelines, but clinic slots have not increased proportionately," Porter said.

The findings were part of a study published July 1 in the Journal of General Internal Medicine. Authors Cynthia Boyd, M.D., M. Reza Skandari, Ph.D., Neda Laiteerapong, M.D. and Porter used 2020 data from the National Health and Nutrition Examination Survey to create model patient panels of 2,500 patients.

The researchers calculated how much time physicians would need each day to handle preventive care, chronic disease care and acute care as well as administrative tasks like documentation and inbox management.  Researchers also accounted for changes to the guidelines that have occurred since earlier studies were published. 

This study builds on others that have found a discrepancy between guidelines and a physician’s time.

In 2003, a Duke University study found that providing the recommended preventive maintenance for patients would take an estimated 7.4 hours out of a primary care physician's day, leaving approximately 30 minutes for critical and chronic disease care.

Another study from Duke in 2005 calculated that doctors would need an additional 10.6 hours per workday to manage the top 10 chronic diseases among their patients.

And it has real consequences for the delivery of health care; the researchers said that time pressure helps explain why improvements in outcomes have not kept pace with advances made in the field, the study said.

“If you do surveys with patients about what frustrates them about their medical care, you’ll frequently hear, ‘My doctor doesn’t spend time with me’ or ‘My doctor doesn’t follow up,’” said Porter in the UChicago article. “I think a lot of times this is interpreted as a lack of empathy, or a lack of willingness to care for a patient. But the reality—for the majority of doctors—is simply a lack of time.”

The authors suggested "team-based care," where nurses, physician assistants, counselors and others help to deliver recommended care, as one solution to the problem of overworked, burned out primary care docs.

Using team-based care, they estimated that amount of primary care physician time could decrease to 9.3 hours per day.

"With team-based care the time requirements would decrease by over half, but still be excessive," the researchers wrote.

The reduced workload breaks into 2 hours a day for preventive care, 3.6 hours per day for chronic disease care, 1.1 hours per workday for acute care and 2.6 hours for documentation and inbox management.

“Team-based care is a movement that has been around in medicine for a while and has gathered steam more recently,” said Porter to UChicago. “Doctors do not give care in a vacuum. There are other extremely important members of the healthcare team that are working together and often independently to provide care for patients. This is a huge opportunity and partial solution to the time constraints currently faced in medical care.”

The researchers used the Comprehensive Primary Care Plus (CPC+) model to develop the estimates for team-based care. The model allows physicians to focus on advanced care and brings in specialized medical professionals to take over other areas. Dietitians, for instance, would handle nutritional counseling for patients with diabetes or obesity, a time-intensive task. Overall, the researchers determined that 65% of primary care services could be handled by other team members.

The researchers noted that moving to a team-care model would require systemic changes to the way the U.S. healthcare system pays for care.