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Workflow Changes Could Relieve Primary Care Physician Shortage

John Commins, for HealthLeaders Media, November 22, 2013

After observing first-hand the workflow at physicians' offices and interviews with clinicians, Shipman and co-author Christine A. Sinsky, MD, a general internist at Medical Associates Clinic and Health Plans in Dubuque, IA, estimated that primary care physicians waste on average about 30 minutes each day, and nurses waste 60 minutes per physician per day, on prescription renewal tasks that policy changes could substantially reduce.

The two physicians believe that eliminating 30 minutes of wasted time each day could translate into 30–40 million more primary care visits available each year without a single additional provider.

"Other efforts to overcome the primary care shortage, by training more, losing fewer, or finding someone else, they all have their place but in and of themselves those are relatively inefficient strategies," Shipman says. "Training more physicians takes a long time and a lot of resources and with current trends in terms of specialty choice it may not yield the workforce we most need."

"Losing fewer physicians has a lot of potential if we change the model of practice to address burnout. But driving inefficiencies out of practice will have a secondary effect on that… The non-physician clinicians such as nurse practitioners and physicians' assistants have an important role, but that too requires training and cost of training and bringing more people in when we can do a lot more with the people we have if we just look critically at how to root out even some of these inefficiencies on a widespread basis."

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9 comments on "Workflow Changes Could Relieve PCP 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