Abstract
BACKGROUND: Primary care physicians are spending fewer hours in direct patient care, yet it is not known whether reduced hours are associated with differences in patient outcomes.
OBJECTIVE: To determine whether patient outcomes vary with physicians’ clinic hours.
DESIGN: Cross-sectional retrospective design assessing primary care practices in 1998.
SETTING: All 25 outpatient-clinics of a single medical group in western Washington.
PARTICIPANTS: One hundred ninety-four family practitioners and general internists, 80% of whom were part-time, who provided ambulatory primary care services to specified HMO patient panels. Physician appointment hours ranged from 10 to 35 per week (30% to 100% of full time).
MEASUREMENTS: Twenty-three measures of individual primary care physician performance collected in an administrative database were aggregated into 4 outcome measures: cancer screening, diabetic management, patient satisfaction, and ambulatory costs. Multivariate regression on each of the 4 outcomes controlled for characteristics of physicians (administrative role, gender, seniority) and patient panels (size, case mix, age, gender).
MAIN RESULTS: While the effects were small, part-time physicians had significantly higher rates for cancer screening (4% higher, P=.001), diabetic management (3% higher, P=.033), and for patient satisfaction (3% higher, P=.035). After controlling for potential confounders, there was no significant association with patient satisfaction (P=.212) or ambulatory costs (P=.323).
CONCLUSIONS: Primary care physicians working fewer clinical hours were associated with higher quality performance than were physicians working longer hours, but with patient satisfaction and ambulatory costs similar to those of physicians working longer hours. The trend toward part-time clinical practice by primary care physicians may occur without harm to patient outcomes.
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The Sandy MacColl Institute for Healthcare Improvement and Group Health Cooperative of Puget Sound leaders providing insight and data access included Matthew Handley, MD, Gary Feldbau, MD, Brian Austin, and Susan Crissman, MPH. Renee Anspach, PhD, and Carol Weisman, PhD, both of the University of Michigan, provided conceptual guidance. Thomas Rice, PhD, and Lynn Soban, MPH, of UCLA’s Department of Health Services, provided editorial review.
This study received financial support from The Blue Cross Blue Shield of Michigan Foundation, Rackham Graduate School, and the Department of Health Management and Policy at the University of Michigan.
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Parkerton, P.H., Wagner, E.H., Smith, D.G. et al. Effect of part-time practice on patient outcomes. J GEN INTERN MED 18, 717–724 (2003). https://doi.org/10.1046/j.1525-1497.2003.20401.x
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DOI: https://doi.org/10.1046/j.1525-1497.2003.20401.x