Primary Care Physicians are Stressed!

Aggravation comes easily when you sit in the waiting room of your primary care physician (PCP), checking your watch as the minutes tick past your appointment time. Or perhaps you’re annoyed that your PCP rushed through your appointment. However, instead of feeling angry, it’s better for you, and your doctor, if you understand that primary care physicians are stressed and overworked.

Why does it seem like PCPs are always running late?

For starters, they are held to tight standard reimbursements by the insurance industry. In the current fee-for-service model, PCPs may have to see 24-25+ patients/day to maintain their salary. Therefore, they can only allot 15-20 minutes for each office visit, which actually translates to only 8-12 minutes of “face time” per patient. Of course, this is not enough time for any patient with a complicated medical history or one who presents with a tricky list of symptoms.

Additionally, over the years, the proportion of patients with difficult to manage chronic illnesses who often need more of the PCPs’ time and effort has increased. As your PCP spends more time with each patient, he/she runs later and later as the day progresses.

How overloaded are PCPs?

Many doctors have 2,000-4,000 patients under their care. Some doctors suggest that a patient load pf 1,000 patients would be better for doctors and patients. Think about this – your PCP likely has thousands of patients to keep track of.  He/she must remember who they are and what medical issues they face. He/she must check test results, read reports from specialists, respond to email and phone messages, and prescribe medications for thousands of patients. That’s a lot!  It’s no wonder that almost 30% of PCPs reported they personally missed test results that led to care delays.

What do PCPs think about the number of patients under their care?

Researchers interviewed many PCPs to learn what they think about their workloads. In general, PCPs felt they should have a maximum of 1,000 patients under their care, perhaps even less if the majority of their patients are elderly or have complex conditions; perhaps as many as 1,500 if most of their patients are healthy. However, in order to meet overhead costs, most of these PCPs reported they had closer to 2,500 patients under their care. However, PCPs who work for a size limited “concierge” practice, have a smaller number of patients under their care. Similarly, doctors who work for a salary at a retirement community don’t have an overwhelming number of patients under their care. For more information, read The Benefits of Concierge Medicine.

Does the number of patients affect care and outcome?

The doctors interviewed who had small numbers of patients (concierge practices and retirement communities) felt they were able to provide better care to their patients. An evaluation by MDVIP, a national concierge practice, showed a 70% to 80% reduction in hospitalizations and ER visits over multiple years and over 90% reductions in readmission rates for certain conditions. Additionally, there have been various studies that show the negative impact of burnout on patient care.

Of course, this makes sense. The more time a PCP (or any other doctor) has with the patient, the more effective the doctor can be. It takes time to hear the patient’s complete story, ask the patient clarifying questions, answer the patient’s questions, do a thorough physical exam, and think about a possible diagnosis and treatment. One doctor interviewed stated: “Time is the one component necessary to be effective“.

Do PCPs like their jobs?

There have been many reports lately of doctors being unhappy and depressed. Increasing numbers of doctors, including PCPs, are reporting burnout. In 2019, one survey found that 44% of doctors describe themselves as burned out.

Many factors are responsible for these feelings, including:

• An increased demand for productivity
• A decrease in the amount of face time with patients.
• An increase in administrative burdens (including filling out electronic forms) that don’t directly benefit their patients.
• Concern regarding income.
• Too many difficult patients.

What does the average workday of a PCP look like?

Want further proof that primary care physicians are stressed? Dr. Richard Baron conducted a year long analysis of the tasks performed in his busy 5 PCP practice with an active caseload of over 8,500 patients and found that every day each PCP:

• Saw 18.1 patients.
• Handled 23.7 phone calls.
• Answered 16.8 e-mails, mostly dealing with test result interpretations.
• Dealt with 19.5 lab reports, 11.1 imaging reports and 13.9 consult reports.
• Issued 12.1 prescription refills, excluding those issued during patient visits.

What can you do?

Yes, primary care physicians are stressed and overloaded. What can you do to maximize your time and your relationship with your PCP? I suggest the following:

• Be patient with your doctor – realize they are overloaded and overworked.  A little compassion from you goes a long way!
• Prepare for appointments!  Before you go, write down your “story”, including your symptoms, when they appeared, triggers, etc.  Also write down a list of questions.
• Take detailed notes at all doctor appointments. Share the information with all members of your medical team at future appointments.
• Keep copies of all important documents (test results, etc) together and organized, and bring them with you to all appointments.
• If something doesn’t seem right, speak up!
• Contact your doctor’s office to learn test results if you have not heard back within the expected time frame.  Do not assume that “no news is good news”.
• Don’t wait for the last minute to contact your doctor for prescription refills, referrals, and other requests.
• If you hate waiting, try to schedule the first appointment of the day, or the first appointment after the doctor’s lunch break.

Learn more…

To learn more about the impact of doctors’ stress, read these posts:

• Doctors’ Stress Impacts Patients
• Doctor Burnout Can Impact Your Health

Even if your doctors don’t appear stressed or overworked, it’s important to be and engaged member of your medical team to get the best care and outcome possible. Read these blog posts to learn more:

• 10 Tips to Communicate Better with Doctors.
• 10 Tips for a Better Medical Appointment.
• Communication Gap Among Doctors.
• Why Take Detailed Notes at Doctor Appointments?
• Should You Record Medical Appointments?
• How Can You Get the Best Healthcare? Actively Participate!
• 6 Tips to Better Manage Your Care.
• Understanding Medical Information Is Harder Than Most Realize.

Note: I updated this post on 12-6-19.