Physician Compensation -- A Deeper Dive: Does Money Make Them Happy?

Carol Peckham

Disclosures

April 15, 2014

In This Article

How Do Physicians Spend Their Time?

Minutes Spent per Patient Visit

The amount of time physicians spend with the patient during a typical visit has not changed significantly over the past few years (Table 2).

Table 2. Amount of Time Spent Seeing Patients in 2010 and 2013 (All Physicians)

Minutes Spent Seeing Patients 2010 2013
9 to 12 minutes 18% 16%
13 to 16 minutes 21% 29%
17 to 20 minutes 17% 25%
25 minutes or more 15% 13%


Regarding primary care physicians specifically, in this year's report, 50% said they spend less than 16 minutes with patients and 48% spend more than 17 minutes, compared with last year's 55% and 42%, respectively, which suggests that patients may be getting slightly more time to talk to their doctors. Hopes are being pinned on wider implementation of the patient-centered medical home (PCMH) as at least a partial solution to improving amount of time spent with patients.[26] Although data are limited and findings on PCMH are mixed to date, an encouraging 2014 comparative study found that physicians in a PCMH intervention group experienced reduced time pressure because they could delegate administrative tasks, which freed up time for longer encounters and more detailed discussions with patients.[27]

Hours per Week Spent With Patients

Less than half (45%) of physicians who responded to the survey spend 40 or fewer hours seeing patients, with slightly over half (51%) spending more time. (Three percent see no patients at all.) Nearly 80% of anesthesiologists and intensivists claim to spend 40 or more hours with patients. In fact, most physicians at the top of the list tend to be hospital-based specialists. Office-based physicians, such as family physicians, pediatricians, and psychiatrists, tend to be on the lower half of the list. Perhaps the reason for this is that these latter physicians might need to spend more time on administrative tasks. According to 2009-2010 data from the Centers for Disease Control and Prevention (CDC), 40% of primary care physicians work evenings or weekends compared with 19% of specialists.[28]

A 2010 study in JAMA found that there was no significant change in hours spent on patients between 1977 and 1997, but those hours decreased steadily from 54.6 to 5.1 hours per week between 1997 and 2007. The decline was observed regardless of gender or employment status, but it was largest for nonresident physicians under 45 and for those working outside the hospitals. The authors attributed the decrease to a parallel 25% inflation-adjusted decline in fees over that same period. They point out that some physicians may have compensated by increasing ancillary services at the expense of patient time. Time spent by physicians working in relatively low-patient-hour specialties, such as dermatology, pathology, and emergency medicine, changed by less than 1%.[29]

In looking at the number of hours that primary care physicians spend on patients in hospitals, an interesting trend emerged: 31% of internists spend more than 25 hours, compared with only 19% of pediatricians and 5% of family physicians. Most likely, the higher percentage reported by internists reflects the rise in hospital medicine over the past decade. The Society for Hospital Medicine estimates that there are more than 40,000 practicing hospitalists, most of whom are internists, up from about 1000 practicing hospitalists 20 years ago.[30]

Number of Patient Visits per Week

Thirty percent of physicians reported seeing between 25 and 75 patients per week and a third between 76 and 124, with a small percentage of physicians seeing either more or fewer patients. (The question was not applicable to 6% of respondents.) According to the CDC, the annual visit load for primary care physicians between 2009 and 2010 was 30% higher than for specialists.[28] In spite of changes related to the ACA, an organization's or practice's revenue will still be determined largely by volume generated by physicians, and therefore the pressure of seeing more patients will still exist. The optimal size of a patient panel is difficult to set, but it is important to balance appointment supply and patient demand.[31]

How Much Time Does Paperwork Take?

Paperwork takes up a huge chunk of time, and self-employed doctors spend more time on paperwork than do employed doctors. About 29% of self-employed doctors say they spend from 1 to 4 hours per week on paperwork vs 24% of employed doctors; 31% of self-employed physicians spend 5 to 9 hours on paperwork vs 28% of employed physicians. Employed physicians spend more time on paperwork than do self-employed physicians only in the category of 20 to 24 hours per week, and only 6% of employed doctors spend that amount of time. It's likely that these may be physicians in administration or academia, or who perhaps are involved in clinical trials.

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