NCPA - National Center for Policy Analysis


April 30, 2010

Dr. Richard Baron -- an internist in a five-provider practice in Philadelphia with roughly 8,500 patients -- conducted a yearlong study using his practice's electronic health record system to evaluate the average daily workload of a primary care physician. 

The results, published in the New England Journal of Medicine, offer "a rare, quantitative look into the mechanics of office practice.  Baron found that on an average workday, each primary care provider in his practice: 

  • Saw 18.1 patients.
  • Handled 23.7 phone calls.
  • Answered 16.8 e-mails, mostly dealing with test result interpretations.
  • Dealt with 19.5 lab reports, 11.1 imaging reports and 13.9 consult reports.
  • Issued 12.1 prescription refills, excluding those issued during patient visits. 

Overall, the practice's physicians worked roughly 50 to 60 hours a week, Baron found. 

Baron said that the results show the need for a new payment method that accurately reimburses primary care physicians for the actual work they do.  According to Baron, who chaired the American Board of Internal Medicine in 2009, the study should signal to policymakers and payers that "... the way you pay us doesn't work for the work we actually need to do." 

While Baron said reimbursing for each phone call or e-mail a physician handles would be impractical, he suggested that adopting capitation, in which physicians would receive an annual lump sum per patient, would better cover the amount of time primary care physicians actually spend on patients. 

Source: Zach Swiss, "What's Keeping Us So Busy In Primary Care?" American Health Line, April 29, 2010; based upon: Dr. Richard J. Baron, "What's Keeping Us So Busy in Primary Care? A Snapshot from One Practice," New England Journal, Vol. 362:1632-1636, No. 17, April 29, 2010.


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