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Workflow Changes Could Relieve Primary Care Physician Shortage

John Commins, for HealthLeaders Media, November 22, 2013

HLM: Will these inefficiencies be addressed more quickly with the advent of physician-employees, or will it make matters worse because salaried physicians will lose their sense of urgency?

Shipman: All employed settings aren't the same and it is not intrinsically the case that private practice doctors have more of an incentive to be efficient than the employed physicians. In some cases, the risk of changing the practice model feels greater in a private practice setting.

What is needed is a revamping of the way medicine is practiced and what a physician does on an hour-to-hour, day-to-day basis. That change may be more risky when everything is on the line by virtue of your role as the breadwinner for the practice. Whereas, in an employed or larger setting, there may be greater opportunity to push for those changes or to enable those changes in the way care is delivered.

HLM: Who needs to lead this efficiency movement?

Shipman: It's an opportunity that physicians shouldn't pass up. They have an opportunity to be in the lead here. They understand better than anyone where their inefficiencies are.

The problem for primary care physicians is that they spend so much of their time running at full speed just to keep up they don't have the time to reflect on how it can be done better. At some level if the physicians don't take the initiative and the screws keep getting tightened down in driving for greater efficiency in overall healthcare delivery and reduced or controlled costs others will step in and push forward.


John Commins is a senior editor with HealthLeaders Media.

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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