To meet all needs without dropping patients, GPs would need to work round the clock and then some.
Ever feel like there aren’t enough hours in the day to provide the care your patients really need?
You would be correct.
An American study which compared US guidelines on preventative, chronic disease and acute care with estimates from doctors of how long each action would take found that it would take a primary care doctor about 26.7 hours per day to deliver guideline-appropriate care.
For the purposes of the simulation study, which was published last month in the Journal of General Internal Medicine, it was assumed each doctor had around 2500 hypothetical patients on their books.
The hypothetical patients were modelled off participants of the 2018 National Health and Nutrition Examination.
For each participant, the University of Chicago researchers calculated the annual time needed to provide preventive care based on the annual time required for each service they were eligible for.
“If the primary care practitioner could provide the service herself, that time was calculated,” they wrote.
“If the service required a referral, the time required for the primary care practitioner to coordinate the referral was calculated.
“These times were summed for each participant to calculate the annual time needed to provide preventive care for each hypothetical panel of 2500 patients.”
The research team applied roughly the same methods to work out the time spent per year on chronic disease and acute care.
Preventative care took up the most time, at an estimated 14.1 hours per day, followed by 7.2 for chronic disease care, 2.2 for acute care and 3.2 for documentation and paperwork.
Unsurprisingly, it was counselling tasks which caused the estimated time needed for preventative care activities to blow out.
“Each preventive care task time varied from less than 1 second/day (medication to reduce breast cancer) to 4.1 hours/day (obesity counselling),” the researchers said.
“Over 10 hours would be spent on counselling tasks, especially dietary or obesity counselling.”
The researchers also modelled the effect of multidisciplinary primary care teams, estimating that allied health staff could at least partially independently complete a large portion of the preventative care tasks.
This would effectively reduce preventative care to two hours per day and chronic disease could go down to around 3.5 hours each day.
Acute care and paperwork stayed roughly the same in team-based care modelling. An improvement, but still roughly nine hours of work per day.
Ultimately, the researchers concluded, it’s unlikely to the point of being physically impossible for many American primary care doctors to be delivering the best care.
“Given the large gap between the time required to provide guideline-based care and the limits of a clinic day, many clinicians are likely not completing specific services, not completing them according to the guidelines, or working overtime,” they wrote in the Journal of General Internal Medicine.
“If time pressures are driving a gap between guideline-based and clinical medicine, it might explain why national health outcomes are worse than expected.”
The researchers also noted that team-based care has the unfortunate side effect of fragmenting patient care, and that one of the challenges to implementing team-based models is a lack of investment in primary care in general.
Lowering the patient base to 1500 people or fewer per doctor – i.e. simulating the effect of adding primary care doctors to the system – was the only non-team based scenario that would give doctors a reasonable working day.
