Study Examines the Day-to-Day Tasks of a Primary Care Physician

A recent review of a five-physician practice in Philadelphia reveals that there are numerous unpaid tasks that a primary care physician must complete during the workday

A new study that examined the typical workday of a primary care physician (PCP), revealing the numerous unpaid tasks that these physicians must attend to during the course of a day. According to the authors of the Washington Post article on the study, this new information may shed light on possible reasons that primary care is becoming an increasingly unpopular field.

Richard J. Baron, MD, of Greenhouse Interests—a Philadelphia-based practice with five PCPs that had an active caseload in 2008 of 8,440 patients—used the practice’s electronic medical record (EMR) system to analyze the daily workload of each physician. During one day of a 50-60 hour workweek, a physician typically saw 18 patients and received 24 phone calls, about 75% of which were fielded by the doctor. Further analysis revealed that one-third of these calls concerned an acute medical problem and resulted in a prescription or an order for a test. A physician also received 17 e-mails over the course of the workday, about one-half of which requested an explanation of a test result.

“The results of the analysis absolutely surprised me," said Baron, who also published the study in the New England Journal of Medicine. "Like everybody else who practices primary care, I feel like I'm running from when I get there to when I leave and take work home. But when I actually saw the numbers of all the tasks, I was really stunned.”

Some additional findings of the study:

- Each physician processed 12 prescription refills a day, in addition to refills that were part of a patient's visit.

- There were 20 lab reports and 11 diagnostic imaging reports (for tests such as X-rays, CAT scans and MRI studies) to review.

- There were 14 reports from consultants—usually other physicians, but also visiting nurses, physical therapists, and other practitioners—to look at and respond to.

“At a time when the primary care system is collapsing and U.S. medical-school graduates are avoiding the field, it is urgent that we understand the actual work of primary care and find ways to support it,” Baron wrote in the NEJM article. “Our snapshot reveals both the magnitude of the challenge and the need for radical change in practice design and payment structure.”