Workflow Changes Could Relieve Primary Care Physician Shortage

Primary care physicians waste on average about 30 minutes each day, and nurses waste 60 minutes per physician per day, on tasks that could be altered to take substantially less time, a study finds.

9 comments on "Workflow Changes Could Relieve Primary Care Physician Shortage"
Rekha Reddy (11/28/2013 at 11:21 AM)

I would like to take this as an opportunity to talk about partnerships between Tech and medicine! All the Counties in the U.S have a major concern now. There will be a huge influx of new patients enrolled and their need to find a medical home soon, I believe Telemedicine should also be one of our options to help medical providers and the County out. Telemedicine may help by bridging the gaps in health access. Newly enrolled patients need to be seen soon, since they may have been without medical care for several years. They may need extensive work ups and specialty care due to possibility of chronic disease and several undiagnosed conditions. We have a huge mismatch of patient to primary care, including specialty care. I have to emphasize, everyone needs care and timely care. Several appointment slots at both primary care and specialty care do not require an extensive physical examination, these visits could be accommodated by providers who are part time or who wish to work more hours from home via telemedicine, from that particular clinic and its satellite sites, by coordinating internally. This would allow health care providers to have the appointment slots open up for the incoming new patients, allowing them to use their time wisely and avoid delaying care for these individuals. Today it takes about 6 weeks for a new patient to see their PCP, and wait time for most specialty care is 3-6 months or worse. This will not be acceptable when we have those new individuals who are eagerly waiting to be taken care of. Telemedicine allows us to see, examine and talk with the patient via HIPPA complaint technology using an iPhone, lap top or iPad. There are many great companies out there trying to solve the health care cost problem. Our Outpatient clinic sites can use telemedicine services for following up and managing lab results, chronic disease including diabetes, asthma, mental health, for following up several radiological and other studies previously performed. The physical outpatient clinic visits could be accommodated appropriately for those new patients, for pregnancy care, for performing procedures on patients and for those who do not get better or who might need extensive work up. I believe telemedicine is also a great way to take care of children at school based health centers. We can also use Telemedicine to help smokers to quit smoking after they have received counseling, because health care providers can actually prescribe medications and take care of these patients without leaving their homes! We can minimize ER visits most of which are usually unnecessary, if the patients have access to the doctors. There are several doctors who are currently part time due to family issues, such as childcare, and would definitely embrace this option of integrating Telemedicine into their work schedule. If we have telemedicine integrated into our County health systems, each health care provider could be focusing on their own county needs, and other counties could do the same. The services are very affordable. This is truly going to be patient centered medical care. If we integrate telemedicine into the County system, patients do not have to miss work or school, drive in that heavy traffic, and sit in the waiting rooms, just for something the provider could share even by phone. There will be less disease and financial burden on the county, if we consider Telemedicine as an option. We need to hasten seeing these new incoming patients who have delayed care for several years. "
Jane Poulter (11/27/2013 at 9:12 AM)

More visits doesn't necessarily mean more efficiency. If the caregiver only focuses on single concern at each visit and doesn't view the patient holistically, then the patient may require multiple visits to actually receive the care he needs. It might be more efficient to provide more time per visit. Potentially the provider could better address more of the patient concerns at one visit and not require as many return visits - this would be a type of efficiency that could be better health care and more satisfaction for a patient.
Diane E Wallis (11/26/2013 at 11:20 AM)

My partner did a quick study. It took 42 "clicks" to enter data on a simple sore throat visit in EPIC's EMR (CPT 99213). Until the burden of data entry in EMR's are lifted, I don't see anything changing in my lifetime. DW
Wayne blount (11/25/2013 at 6:49 PM)

What a crock!
Beth D MD (11/25/2013 at 6:38 PM)

I am so distressed with the direction of primary care. It treats primary care providers like dogs and works them to the bone at the cost of their families...or the cost of their sanity! Note high suicide rates amongst physicians. This is insane. We all want Marcus Welby but we want him for free and for 15 minutes or less. And we want him to bear all the burden of changing our bad habits. All the legal liability of life's poor outcomes. We show him no respect. We pay him less and less. We bury him in piles of paper. We impose an EMR for him to pay for that slows him down. Is the cost of medicine at the level of the primary care provider inefficiency? BULLPOOP I say! The cost is technology and pharmaceuticals and regulation. At the bottom of the pile of poo are the doc and the patient. But they are easy to punish. And so we do. So America, beware of getting what you wish for. A smart, promising young man or woman will choose another profession. One that won't make him wonder if he has time to eat or pee that day. Wonder why he sacrificed his young adulthood for this be...what? The low man on he totem pole subject to the desires of everyone else. Forced into a priesthood of servitude... At least for a generation...until they stop coming to the alter. Stop beating up doctors and patients. Stop the useless regulation. Give me more time to care for human beings who fail to conform to the minutes allotted them. Pay me appropriately for he life saving work I do over and over every day. Take the insane pressure out of my exam room and I will give you better results. Oh, and require the patient to do his part too.... Don't make his poor decisions and poor outcome a reflection of my quality. God made quality work. Yet Adam and Eve didn't comply. So who's fault is that?
Jean Antonucci (11/25/2013 at 4:31 PM)

There is nothign here that is unknown to most of us; but I find the slant of the article somewhat insulting. The time we waste in the best of offices is not"doctors and nurses wasting time" It is time wasting chores imposed upon us, that we cannot change.That is a big difference. For instance the requirement here in Maine is that we must log our refrigerator and freezer temps twice a day on paper, twice a day into a special Webster we need a password for- a password that if lost must be obtained via a real person who goes home at 4:30. AND we had to learn an automatic usb loaded device to record max and minimum temps daily AND detach it then upload it to the state q month. There are endless more examples of bureaucratic office elves out there with the authority to say "but we need this" and DR Sinsky et all would do better to stop accusing physicians about wasting time and to re design their offices, and become a public advocate for tools that work for us.Lots of well intentioned stuff here but insulting .We don't waste time. It is wasted by conflicting directives and lack of design of a functional health care system
Caroline Abruzese, MD (11/25/2013 at 1:29 PM)

The average primary care physicians works non stop to see 24+ patients a day, write notes, make phone calls and is lucky to complete this in 10 ours. Is a pause to consider a case a waste of time? Or is it the moment to sit or eat lunch that this author finds inefficient? For me, it was the reading of this article.
Francis Wiederman, M.D., FACEP (11/25/2013 at 1:02 PM)

The EHR is designed and marketed to increase billings and revenue. The EHR is not designed to assist the MD/DO/NP/PA to quickly and easily assess old and to record new information. EHR is a billion dollar industry and as such is serving itself very well. As such, without physician input and control at the points of design and usage, the EHR remains moderately helpful but a burden to the practicing health care provider. Thus, Dr. Shipman's conclusions are incomplete.
Dike Drummond MD (11/22/2013 at 6:13 PM)

Love it when experts call out docs and nurses for "wasting time" when they are running on their gerbil wheels as fast as they can. Case in point. EMR was supposed to help with the work flow and has only made it worse. Here is a quote from last month's RAND/AMA study on Physician Satisfaction: ""We found that EHR usability represents a relatively new, unique, and vexing challenge to physician professional satisfaction. Few other service industries are exposed to universal and substantial incentives to adopt such a specific, highly regulated form of technology, which has, as our findings suggest, not yet matured." So if we are going to call physicians and nurses out for wasting time ... let's come with a solution that actually helps at the same time. EMR is NOT IT at this point. The most promising development in Primary Care is a well implemented PCMH and most of the efficiency comes from a Team Focus. Unfortunately you have to retrain docs on how to lead teams like this. My two cents, Dike Dike Drummond MD TheHappyMD (dot) com


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