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Spending time with patients: the impact of organizational structure on medical practice
Insights
Physician practice organization significantly impacts patient visit duration. Solo practitioners and internists generally spend more time per patient, while Health Maintenance Organization (HMO) structures can influence time allocation differently.
Area of Science:
- Health Services Research
- Medical Practice Management
- Healthcare Economics
Background:
- Physician practice organization is a key determinant of healthcare delivery.
- Understanding how different organizational structures influence physician time allocation is crucial for optimizing patient care and resource management.
Purpose of the Study:
- To examine the relationship between physician practice organizational structure and the time spent per patient visit.
- To compare time spent across various practice types, including fee-for-service (FFS) and Health Maintenance Organizations (HMOs), and different physician specialties.
Main Methods:
- Analysis of pooled data from two national studies involving 2,521 physicians.
- Comparison of patient visit times (overall, in-office, and in-hospital) based on practice structure, payment models, and physician specialty.
Main Results:
- Solo practitioners spent more time per visit than group practitioners.
- Internists and obstetrician-gynecologists spent more time per visit than general practitioners.
- Physicians in prepaid group practices and staff model HMOs showed varied time allocations compared to FFS practices; salaried physicians spent more time per visit than non-salaried physicians.
Conclusions:
- Physician practice organization, including solo vs. group, FFS vs. HMO, and payment models, significantly affects patient visit duration.
- Findings have implications for future research on practice organization and its impact on medical practice patterns and efficiency.
Abstract:
This article assesses whether the amount of time that physicians spend overall, in the office, and in the hospital per patient visit depends upon the organizational structure of the physician's practice (i.e., does the physician practice in the fee-for-service system or in an HMO, and if in an HMO, in what type of an HMO). Data pooled from two national studies (N = 2.521) reveal several interesting patterns, including: 1) on all measures, solo physicians spend more time per patient visit than physicians in group practice; 2) overall and in the office, internists spend more time per patient visit than general practitioners; 3) overall and in the hospital, obstetricians-gynecologists spend more time per patient visit than general practitioners; 4) overall and in the office, physicians in prepaid group practices spend less time per patient visit than physicians in fee-for-service group practices; 5) overall and in the office, physicians reimbursed on a straight salary basis spend more time per patient visit than nonsalaried physicians; and, 6) in the hospital, physicians in staff model HMOs spend more time per patient visit than physicians in fee-for-service group practice. The implications of these findings for future studies of the effects of organizational structure on medical practice are discussed.