Average Physician Office Visit Time Not Shortened, Study Says
"[D]ebunking" the notion that managed care pressures doctors to spend "less time with patients than they did 10 years ago," a Rutgers University study released today says that doctors now are spending between one and two minutes more with patients than they did in 1989, the Newark Star-Ledger reports. The study, published in this week's New England Journal of Medicine, examined doctor surveys compiled between 1989 and 1998 by the National Center for Health Statistics and American Medical Association. Average office visits for managed care patients increased from 15.4 minutes in 1989 to 17.9 minutes in 1998, while office visits for patients with traditional insurance increased from 16.4 minutes to 18.5 minutes in the same time period. Lead researcher David Mechanic said, "This is contrary to what everyone expected. It's clear that the time doctors spend with patients has been going up over the decade, not down." The study also found that while traditional fee-for-service visits consistently were longer than managed care visits, that gap declined from one minute in 1989 to 0.6 minutes in 1998 (Campbell, Newark Star Ledger, 1/18). The trend of longer office visits "generally applied regardless of whether a patient had insurance." However, between 1995 and 1998, visits to all medical specialists by the uninsured shortened by 2.7 minutes. The trend in longer visits "peaked" between 1994 and 1995 and "has been declining since then" (Mishra, Boston Globe, 1/18).
The Rutgers study contrasts with a 1999 study by the Kaiser Family Foundation and the Harvard School of Public Health that found that 83% of doctors said they were spending less time with patients "because of managed care," and that 64% of patients said that doctors were spending less time with them for the same reason. Mechanic said that doctors might be "blaming managed care for problems that are more complex in origin." For example, he said that with a rising number of doctors, physicians are competing for patients and spend more time with them in order to "try to keep [them] happy." Furthermore, doctors "now are expected to do more during their office visits," such as counseling patients on weight loss or smoking cessation, Mechanic said (Burling, Philadelphia Inquirer, 1/18). Trying to explain why the study is "so at odds with the perceptions," Dr. Edward Campion writes in an NEJM editorial, "The sense of not having enough time should be understood as a reflection of the wider problems and pressures that physicians face. The misperceptions about the length of office visits may be a symptom of physicians' discontent with the system" (Campion, NEJM, 1/18). For example, David Swee, chair of the department of family medicine at the University of Medicine and Dentistry of New Jersey-Robert Wood Johnson Medical School, says that doctors work longer hours and hire additional staff to "find more time for patients and still meet the requirements of managed care plans." Swee added that doctors also take time during office visits to talk to patients about insurance, referrals and pre-certifications.
But Dale Florio, spokesperson for the Trenton, N.J.-based New Jersey Association of Health Plans, said that this study should "comfort patients and doctors in the fact that the [managed care] system can work" (Newark Star-Ledger, 1/18). Karen Ignagni, president of the American Association of Health Plans, added, "This study is an important contribution to the dialogue about managed care, because so much of the discussion really is anecdotally driven. This study indicates that the experience is often very different from the rhetoric." But the Wall Street Journal reports that "critics" say that the study "fails to shed enough light on ... a broader disparity in the quality of treatment between patients" with traditional insurance and those under managed care. Harvard Medical School associate professor David Himmelstein said, "There's no way in this data set to look at the severity of illness of a given patient. There's still a fair amount of data out there that tells us that managed care patients receive less care" (Guidera, Wall Street Journal, 1/18). To read the abstract of the Rutgers study, go to