Primary care physicians spending longer time with patients

The number of adult visits to primary care physicians increased between 1997 and 2005, and the visits lasted longer, according to a Nov. 9 Archives of Internal Medicine study.

The study examined whether a 10% decline in physicians' net income from 1995 to 2003 might have produced shorter visits as physicians tried to make up for lost revenue by seeing more patients.

The reverse was true. The average visit increased from 18 to 20.8 minutes. And there was greater use of quality measures, such as medication reviews and blood pressure screenings, the study said.

"It's reassuring that in spite of increased pressure to be efficient, it doesn't look like primary care physicians are spending less time with their patients," said lead author Lena Chen, MD, a clinical lecturer in internal medicine at the University of Michigan Health System.

A second study found that patients in emergency departments wait longer to see a physician, even those who require the most urgent care. Researchers said one in four ED patients in 2006 waited longer than recommended for triage -- up from one in five patients in 1997.

In 1997, patients waited a median of 22 minutes after they arrived in the ED. By 2006, the wait was 33 minutes.

"We've known for a long time that EDs are more crowded, but I think most people had the sense that, 'If I come in with my heart attack, they will see me right away,' but that's not true," said Leora Horwitz, MD, lead author of the ED study and assistant professor of medicine at Yale University in New Haven, Conn.

In the primary care study, researchers analyzed 46,250 visits to primary care physicians by adults ages 18 and older from 1997 to 2005. They used data from the National Center for Health Statistics' National Ambulatory Medical Care Survey.

Researchers estimated that the number of primary care visits increased from about 273 million visits annually in 1997 to 338 million visits in 2005. Duration increased 3.4 minutes for general medical exams, 4.2 minutes for diabetes care, 3.7 minutes for hypertension and 5.9 minutes for joint diseases such as arthritis.

More complex patients being seen

Since the general population is aging, caring for more older and sicker patients may be responsible for longer visits, researchers said. Patient participation in clinical decision-making also might have contributed.

"Visits are increasingly involving patients with multiple chronic conditions and on multiple medications," said Joseph W. Stubbs, MD, president of the American College of Physicians. "It's not surprising to me that the researchers found an increase in time per visit. What was pleasing to see was an increase in quality associated with that."

The emergency care study examined 151,999 ED visits from 1997 to 2006 and found that the percentage of patients seen by a physician within the time recommended had declined steadily. By 2006, the figure was at its lowest point in at least 10 years.

David Ross, DO, a spokesman for the American College of Emergency Physicians and an emergency physician at Penrose-St. Francis Health Services in Colorado Springs, Colo., said longer wait times for emergency care are linked to hospital closings and increasing numbers of patients.

There were more than 119 million ED visits in 2006 compared with 93.4 million in 1994, according to the study. At the same time, the number of EDs fell from 4,019 to 3,833.

Both studies pointed out a need for more health care professionals, including nurse practitioners and physician assistants, in all settings. The primary care study also called for higher payments for physicians.

"My hope is that we can incorporate this news into alternative models of primary care that can do an even better job of providing quality without keeping physicians on a hamster wheel," Dr. Stubbs said.