Center for Studying Health System Change

Physicians: So Much to Do, So Little Time

Despite More Time Spent on Patient Care, More Doctors Bemoan Lack of Time with Patients

New Release
May 7, 2003

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ASHINGTON, D.C.—While physicians spent about two additional hours a week on patient care in 2001 than in 1997, more doctors say they don’t have enough time with patients, according to a national tracking study released today by HSC.

The proportion of time physicians spent in direct patient care activities increased from 81 percent in 1997 to 86 percent in 2001. Nonetheless, the proportion of physicians reporting inadequate time with patients grew from 28 percent in 1997 to 34 percent in 2001.

Possible explanations for the growing number of physicians who feel pressed for time with patients include increased diagnostic and treatment options, managed care plans’ easing of tight restrictions on care, people living longer with chronic illnesses that may require more complex coordination among caregivers and a growing list of recommended preventive services, the study noted.

"As the practice of medicine grows more complex, physicians may be frustrated because they have too much to discuss with their patients in too little time," said Paul B. Ginsburg, Ph.D., president of HSC, a nonpartisan policy research organization funded exclusively by The Robert Wood Johnson Foundation.

The study’s findings are detailed in a new HSC Tracking Report—So Much to Do, So Little Time: Physician Capacity Constraints, 1997-2001—available by clicking here. The study is based on results from HSC’s Community Tracking Study nationally representative Physician and Household Surveys, which involve about 12,000 physicians and 60,000 consumers, respectively.

Other signs of strained physician capacity include patients waiting longer for appointments and fewer physicians willing to accept all new patients. Yet, the supply of physicians grew modestly, more medical practices employed nurse practitioners and other nonphysician caregivers, and the average number of doctor visits per person annually remained constant between 1997 and 2001.

Signs of strained physician capacity have emerged as the health care marketplace shifted away from tightly managed care practices that restricted patients’ access to physicians and gave them more freedom to seek care without substantial out-of-pocket cost increases, the study noted. Current physician capacity constraints may ease if higher out-of-pocket costs prompt patients to seek less care.

"The real question is whether the current imbalance between physician capacity and patients seeking care is a blip on the radar screen or a longer-term problem," said HSC Senior Health Researcher Sally Trude, Ph.D., the study’s author.

"In 2001, we still had a tight labor market, and many employers were reluctant to pass higher health care costs to workers, making only small increases in workers’ deductibles and copayments," Trude said. "As health insurance premiums continue to skyrocket, employers are more aggressively shifting higher costs to workers, and that may prompt people to seek less care and ease current physician capacity constraints."

Other key findings include:

• The time physicians spent in direct patient care activities grew from 44.7 hours a week in 1997 to 46.6 hours a week in 2001. While physicians spent more time on patient care activities, their average medically related work week fell from 55.5 hours in 1997 to 54.4 hours in 2001. Combined with the finding that more physicians feel they don’t have adequate time with patients and that people didn’t go to the doctor more frequently, the increase in physicians’ time spent in patient care suggests they are spending more time on patient care activities other than face-to-face visits with patients.
• More physician practices employed physician assistants, nurse practitioners, nurse midwives and clinical nurse specialists, with the proportion of physicians in noninstitutional practice settings working with these caregivers growing from 40 percent in 1997 to 48 percent in 2001. The trend was most pronounced for group practices of three or more physicians, where the proportion grew from 53 percent in 1997 to 66 percent in 2001.
• The proportion of Americans who saw a physician at least once a year increased slightly between 1997 and 2001, from 77 percent to 78 percent. Although slightly more people saw a doctor and physicians spent more time in direct patient care, the average number of doctor visits per person remained constant between 1997 and 2001 at about 3.8 visits.
• Waiting times for an appointment with a specialist grew between 1997 and 2001, while waiting times for primary care appointments remained unchanged. Half of all patients waited 8.1 days or longer in 2001 to see a specialist for a specific illness, compared with 6.6 days or longer in 1997. Half of all patients seeking an appointment with a primary care physician for a specific illness waited about a day in both 1997 and 2001.
• The proportion of primary care physicians reporting problems arranging specialty referrals increased from 4.8 percent in 1997 to 7.2 percent in 2001.
• The proportion of physicians accepting all new Medicare patients fell from 73 percent in 1997 to 69 percent in 2001, while the proportion of physicians accepting all new privately insured patients fell from 70.8 percent to 68.2 percent.
• The proportion of patients who delayed or did not get care because they couldn’t get a timely appointment grew from 3.4 percent in 1997 to 5 percent in 2001.

The Center for Studying Health System Change is a nonpartisan policy research organization committed to providing objective and timely insights on the nation’s changing health system to help inform policy makers and contribute to better health care policy. HSC, based in Washington, D.C., is funded exclusively by The Robert Wood Johnson Foundation and is affiliated with Mathematica Policy Research, Inc.