By Michael P. Broxterman, Chief Operating Officer, Pinnacle Health Group, and Terry Lane, Staff Writer
Тhe Problem
The “Time Squeeze” – every physician experiences it from time to time, but many are dealing with it every day of every week, as physicians are pressured to see more patients in less time. As waiting rooms pile up with patients spending as long as an hour waiting to see their physician, physicians are wondering how much longer they can continue to work 80+-hour weeks with limited or no call coverage.
“In the last few years, we’ve gotten more calls from physicians complaining about their hours and call coverage,” says Michael P. Broxterman, Chief Operating Officer and Vice President of Pinnacle Health Group (Atlanta). “They are looking for a higher quality of life, time off once in a while, time with their families – but they are also expressing concern for their patients,” says Broxterman, adding “They aren’t happy with the amount of time they are able to spend with each patient. They are frustrated, and it comes through during the interview.” Broxterman says that physicians from all over the United States are experiencing the ‘time squeeze’ due to shortages in specific specialties all over, and shortages in primary care in rural and other difficult-to-place areas.
According to a recent article by Sally Trude (HSC), between 1995 and 2000, the number of physicians increased from 260 to 276 physicians per 100,000. How can there be shortages if there is an increase in physicians? Trude’s article explains that although there are more physicians, patients are living longer, they require long-term care, and with increased treatment capabilities, increased need for diagnostic interpretation, and more preventive care needs, patients are requiring more office visits over a longer time span. “There simply aren’t enough of us to provide the time required to treat all of our patients with the care and quality that we would like to,” says one Atlanta physician. Preventive care is taking up more of physicians’ time than it has in the past. Trude’s article states “A recent study estimated that if doctors followed all government recommendations aimed at preventing disease and injury, they would spend more than seven hours a day on the standards.”
The HSC survey also reports that physicians are less willing to accept new patients due to time constraints, which leaves communities without adequate healthcare coverage. Frustrated clients are depending on recruiting firms to urgently fill these vacancies. In some communities, patients are often seen by nurse practitioners, midwives, clinical nurse specialists and physician assistants instead of a physician. Physicians who utilized these healthcare professionals in their stead increased from 40% to 48% over the 1997-2001 time span. Group practices of three or more physicians were most likely to utilize healthcare professionals to treat patients.
The Affect
In 2001, patients waited approximately 8.1 days to see a specialist for a specific illness. Many specialists were less willing than primary care physicians to accept new patients simply because they did not have the time to see them. At the top of this list were surgical specialists who only accepted new patients 45% of the time in 2001.
Communities across the country are feeling the effects of the time squeeze. Physicians are considering positions they would never have considered in the past (such as opportunities in rural areas), simply because they would have fewer patients, fewer hours, and more free time. “It isn’t that doctors don’t want to work, we just don’t want to work 70 and 80 hour weeks every single week. We need off time too, we need downtime so that we can give better care to our patients,” says one Gastroenterologist from Boston.
The difficulty is that since there is a shortage of physicians (which is projected to get worse) and the hours that physicians are working is going down (especially in physicians coming out of medical school) then as the patients stack up in the waiting room, the only thing physicians can do about it is spend less time with the patient. Today’s physician must be just as effective treating sick patients as physicians in the past have been with much more time per patient.
The Solution
Says Broxterman, “physicians have always noticed shortages in rural areas, and there has always been a distribution problem. Training programs have not kept up with the demand and there is an increased need for health care as patients’ needs have grown. The problem isn’t going to go away any time soon. Many physicians are overworked and many communities are under served. Recruiting firms are in the middle, trying to provide physicians with opportunities that will improve their quality of life, while trying to fill vacancies in the underserved communities where opportunities may demand long work hours.”
The solution has been for physicians and clients to come up with creative workarounds, compromises, and efficiency processes. Physicians are utilizing technology to manage medical records and other office processes. “There is a lot of information available to physicians today to help them be more efficient, to help them manage time to their fullest potential,” says Broxterman.
“Recruiting firms must continue to be sensitive to the importance of quality of life, and to understand that providing quality care within a community is a balancing act,” says Broxterman. Often times that means working with the client that is recruiting in setting up an opportunity that is attractive to the new candidate out in the marketplace. If the situation is set up right and the recruiting firm does their job, then we can begin to turn around a situation that has a lot of turnover. Hopefully, as the right balance of residents are graduated within particular specialties and recruiters do a good job matching up the technical as well as social needs of the candidate and client, then communities and physicians will begin to feel less squeezed for time. That’s our goal.
1. Tracking Report from HSC Community Tracking Study Physician Survey. Visit www.hschange.org for more information. Based on an article written by Sally Trude, located at http://www.hschange.org/CONTENT/556/ on March 18, 2003. TRACKING REPORTS are published by the Center for Studying Health System Change.
2. Tracking Report from HSC Community Tracking Study Physician Survey. Visit www.hschange.org for more information. Based on an article written by Sally Trude, located at http://www.hschange.org/CONTENT/556/ on March 18, 2003. TRACKING REPORTS are published by the Center for Studying Health System Change