Do Physicians Have the Time for Quality?

Janice Simmons, for HealthLeaders Media , November 12, 2009

Providing appropriate counseling or screening generally took 2.6 minutes for diet, 2.7 minutes for blood pressure check, and 4.2 minutes for exercise counseling. Providing appropriate medication therapy, however, was not associated with longer visit duration.

On average, visits with general internists were 1.7 minutes longer than those visits with family or general practitioners. Other characteristics, though, such as practice location in a metropolitan area and physician ownership of the practice, were not associated with differences in duration.

Overall, in regard to patient factors, older patients had longer visits—18.4 minutes for those 76 or older—compared with 16.7 minutes for those ages 18 to 35.

The findings suggest that the relationship between visit duration and quality of care depend on the type of quality indicator.

Overall performance on clinical quality metrics was poor. Better performance on medication quality measures did not seem to require extra physician time, while better performance on counseling or screening indicators was associated with longer visit duration.

"Improvements in quality of care will likely require a combination of investments in systems, such as electronic health records, greater use of other professionals, such as nurse practitioners, and better reimbursement to primary care physicians for the extra time spent," they concluded.

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Janice Simmons is a senior editor and Washington, DC, correspondent for HealthLeaders Media Online. She can be reached at

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