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Part-time physicians. Physician workload and patient-based assessments of primary care performance
A Murray1, D G Safran, W H Rogers
1Health Institute, New England Medical Center, Boston, Mass., USA.
Objective:
To examine the relationship between the number of hours physicians work and patients' assessment of the physician.
Design:
Cross-sectional study with physician and patient surveys.
Setting:
Primary care practices in Massachusetts.
Participants:
A random sample of 6810 Massachusetts state employees in 15 different health plans.
Main Outcome Measures:
Eleven summary scales measuring 7 essential elements of primary care. Information was derived from the Primary Care Assessment Survey, a validated patient-completed questionnaire.
Results:
Physicians were classified into 3 groups according to their reported hours of work: "overtime" (> 65 h/wk), "full time" (40-65 h/wk), and "part time" (< 40 h/wk). There was no statistically significant difference between the 3 groups of physicians in 10 of the 11 measures of primary care performance. Physicians who worked more than 65 hours per week were found to score significantly higher in the visit-based continuity of care category than physicians working fewer hours. Physicians working more than 65 hours per week were also found to be significantly less satisfied with the amount of time they had for family and personal life than the other 2 groups.
Conclusions:
Part-time physicians perform as well as full-time physicians in most aspects of primary care, including all interpersonal aspects of care, as reported by patients. Patients of physicians working more than 65 hours per week experienced higher levels of visit-based continuity of care than patients of physicians working fewer hours, but this appears to carry a cost to those physicians in the area of personal and professional satisfaction. Subsequent research should examine the relationship between physician workload and technical aspects of care.