Thursday, June 5, 2014

The statistics of today’s patient totals

Excerpted from How many patients should your doctor see each day? commentary by Lenny Bernstein in The Washington Post. May 22, 2014 — In light of the allegations that some Veterans Affairs Department health clinics used elaborate schemes to hide the records of patients who had waited months for care, I began to wonder what a normal caseload would look like for an average physician outside the VA system. And if your doctor has a larger-than-average caseload, is he or she able to give you the attention you need?

The numbers are pretty stunning. A 2012 article in the Annals of Family Medicine noted that the average primary-care physician has about 2,300 patients on his “panel”— that is, the total under his or her care. Worse, it said that each physician would have to “spend 21.7 hours per day to provide all recommended acute, chronic and preventive care for a panel of 2,500 patients.”

According to a 2013 survey by the American Academy of Family Physicians, the average member of that group has 93.2 “patient encounters” each week — in an office, hospital or nursing home, on a house call or via an e-visit. That’s about 19 patients per day. The family physicians said they spend 34.1 hours in direct patient care each week, or about 22 minutes per encounter, with 2,367 people under each physician’s care.

In 2012, the Physicians Foundation, a nonprofit group, surveyed 13,575 doctors across the United States and found that 39.8 percent see 11 to 20 patients per day and 26.8 percent see 21 to 30 a day. In an email, Lou Goodman, president of the foundation, wrote that “physicians are working fewer hours, seeing fewer patients and limiting access to their practices in light of the significant changes to the medical practice environment. The research estimates that if these patterns continue, 44,250 full-time-equivalent physicians will be lost from the work force in the next four years.”

Commentary

Dr. Thomas EppesCMDA Member Thomas Eppes, MD:“The article from the Post raises multiple questions and thoughts from multiple perspectives in seeking to answer the question of how many patients a doctor should have under their care. If you are the patient, the answer is easy, one and it’s me. If you are the physician, the answer is enough to survive, enough to ‘bring home the bacon, enough to pay back the loans, enough to meet the requirements of my contract, enough for whatever your financial goals might be, etc. If you are the physician’s spouse, just enough to support the family and still get home to be with them and the kids. We could go on and on.

“The world is creating multiple pressures on physicians to see more patients, more efficiently, more electronically, with higher quality and even perfect quality, at no greater cost.

“Solutions for individuals include abandon ship, to retire, to go part-time, to do concierge practices or to build highly efficient teams. The days of seeing patients on a merry-go-round at full speed ahead are quickly disappearing as we move from volume driven care to quality proven population management. The proven and comfortable model of the past has to be altered in a quantum way as new and unproven ‘solutions’ pop up. It is quite unsettling, especially for those nearing the end of their practice life.

“What did our Lord do? Obviously, if there ever was one under a time constraint it would have been He. Yet He never ran anywhere, and He was fussed at for not being timely by others not being cared for at that moment. Yet the Bible tells us He met every ‘patient’ where they needed to be met.

“As each of us struggles with our individual station in our walk on this earth, we need to be ever mindful that we are accountable to only our Lord for how we meet His calling for our lives. We should each day see each patient encounter as our opportunity and appointment to glorify Him as we do His work on this earth, whether it be one patient, 30 or 100. This is what those who are trusting us to care for them want and deserve. Prayerfully, each healthcare professional can do this only if our eyes are on Him as He gives us the wisdom, energy, grace, insight and stamina to do His will every day.”

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1 comment:

  1. Eric Potter - SMCCJune 19, 2014 at 3:34 PM

    Thanks for drawing some attention to this issue. I once worked with a physician who regularly saw 30 or more in the office each day and then rounded on another 20 to 30 in the hospital. He also covered several nursing homes in the area.

    Many asked how he did this... 1) Sometimes worked from 7am to 11pm. 2) Repeatedly was behind on dictations until forced by administration to do them or else. 3) Skipped patients on the weekend in the hospital. 4) He didn't answer all his phone calls.

    Our system is driving doctors to madness. The sad part is... We have seen the enemy and he is us. Until Christian Doctors take a stand and lead the way to better care for our patients, we are just as guilty as the non-Christian described immediately above. May God enable me to change that.

    Eric Potter MD
    SMCC

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