An article in this week’s New England Journal of Medicine, the subject of a story here yesterday merits a second look. (TPR story includes tips to make most of your doctor visit.)

Many people talk about how hard primary care physicians work but, until now, there have been few studies which examined exactly how hard their days are.

Highly skilled doctors often are able to mask the frenetic activities that make up their days when working with patients—but when one says every minute is a valuable commodity, this proves it.

Summing up the facts from an excerpt of a story in the Washington Post story and the original NEJM article, you see what’s wrong with a primary care doctor’s day and why so few medical students now choose it.

A five-physician practice in Philadelphia caring for 8,440 people used its electronic medical records system to analyze the daily work of each practitioner.

1. 18 patient visits per day per doctor—with most patients coming in two times a year.

2. Workweek was 50 to 60 hours.

3. 24 phone calls a day. 16 of these were handled by the doctor. The other 8 went to staff.

4. 8 of the 24 daily calls was about an acute problem, needing an RX or test order.

5. 17 e-mail messages per day came in. Half wanted test results explained.

6. 12 RX refills per day not counting those that are done as part of a visit.

7. 20 lab reports and 11 imaging reports (X-rays, CAT scans and MRIs) to check.

8. 14 specialists, or consultants—MDs, visiting nurses, PTs and others—reports for action.

The Washington Post

“In addition to seeing patients, a primary-care physician each day must address more than three dozen urgent but uncompensated tasks, according to a study that provides a rare, quantitative look into the mechanics of office practice.

“Answering telephone calls and e-mail messages, refilling prescriptions, reviewing lab test results and consulting with other doctors consume large amounts of time each day, even though none of it is paid for, according to the study.

“Primary care is a centerpiece of the recently enacted health-care law, which provides incentives for doctors, nurses and physician assistants to enter the field. Many experts — and President Obama — have said that the 32 million additional people expected to get health insurance over the next decade will need primary-care providers if the law is going to both improve the quality of medical care and contain spending, its two goals beyond expanding coverage.

“Primary care, however, is an increasingly unpopular field, and the new study sheds light on possible reasons.”

Source: Washington Post, April 29, 2010

Citation: New England Journal of Medicine, Volume 362: 1632-1636, April 29, 2010, Number 17.