Docs Spend More Time with Patients, but Racial Disparities Still Present

Between 1978 and 2018, the amount of time patients spend each year with an outpatient physician has increased by around 20 minutes, but data still reveal troubling findings of racial disparities in physician face time and patient-provider communication in primary care settings.

The study, published in the Journal of General Internal Medicine, particularly found that the amount of time patients spend with any outpatient physician annually grew from 40 minutes to 60.4 minutes. On the surface, this is a good thing, considering the role that patient-provider communication and relationships play in patient care.

Patients who spend more time with their physicians may receive stronger patient engagement and patient education, while also feeling more comfortable with their providers, two things that can positively contribute to clinical quality outcomes.

“Acquiring a history, performing a physical exam, interpreting a study, formulating a diagnosis, conducting a procedure, providing counseling, and developing a well-considered treatment plan all require the expenditure of time by an individual clinician to an individual patient,” the researchers wrote in the study’s introduction.

“Yet physician time is a finite resource,” the research team added.

Physicians—and all clinicians—are facing staggering levels of burnout, strapped for time to complete the administrative and patient-facing tasks to which they are beholden, as well as reserve time for self-care.

Even still, physicians both in primary care and outpatient specialties are managing to spend more time with their patients, the data showed. In an analysis of data regarding 1.1 million patients visiting an office-based physician between 1978 and 2018, the most recent year for which there is data, the researchers found a 20-minute increase in physician face time.

But that increase isn’t all good news, the researchers added. Although overall annual physician face time went up, time spent with primary care providers has actually gone down by around 10 percent since 2005; that decrease was offset by an increase in specialty physician face time.

These findings may indicate shifting priorities away from primary care, according to Steffie Woolhandler, MD, a primary care physician and Distinguished Professor at the City University of New York’s Hunter College and a lecturer at Harvard Medical School.

“Our findings provide yet another indicator of the skewed priorities of our healthcare system,” Woodhandler said in a statement emailed to journalists. “All Americans suffer because of the imbalance between primary and specialty care. We devote meagre resources to primary care and prevention, the bedrocks of quality care, and the primary care deficit is increasing,” she added.

What’s more, the study, which utilized data from the National Ambulatory Care Survey, showed stark racial disparities in how physicians allocate their face-to-face patient interactions. On the whole, White patients spent more time with an outpatient physician than patients of color.

Nearly every racial group saw an increase in physician face time over the study period, the researchers reported, but the gains Black and Hispanic patients saw paled in comparison to the gains White patients said. While White patients saw their physician face time increase by nearly 25 minutes, face time only increased by 15 minutes for Black people and 23 minutes for Hispanic people.

Said otherwise, the disparity in physician face time between White and Black patients went from 13.1 minutes to 22.9 minutes, and the gap between White and Hispanic patients grew from 11.6 minutes to 14.7 minutes.

These disparities could stem from lower rates of insurance coverage and more limited access to comprehensive insurance coverage among Black and Hispanic people. Black and Hispanic patients may be encumbered by cost-related care access barriers, like copayments and deductibles, while implicit (or explicit) bias in healthcare could spur mistrust and discourage access, the researchers offered.

That limited time spent with a physician could have downstream effects that spur on further racial health disparities. A Black or Hispanic patient who does not spend enough time with a primary care physician each year may not have an illness detected or receive the health coaching and engagement necessary to guide patient wellness.

Poor health outcomes become a self-fulfilling prophecy, according to Woolhandler.

“Because we treat healthcare as a market commodity, Black Americans and other groups with high poverty rates who have the highest rates of illness and death can’t get the care they need,” she said.

Adam Gaffney, MD, a pulmonary and critical care physician at Harvard Medical School and the Cambridge Health Alliance said these findings suggest a reassessment of how, and with whom, outpatient physicians spend their time.

“Physician time is a finite resource: it should be allocated on the basis of medical need, not financial means, race, or ethnicity,” Gaffney said in a statement. “It takes time to diagnose illness, think through a treatment plan, and provide personalized counseling – actions that are the essence of good doctoring.  Our findings indicate that physician time is allocated unfairly and irrationally. Change is needed ensure that patients get the care they need.”