Expanding Primary Care Capacity by Reducing Inefficiency

Producing more healthcare providers is often touted as the principle solution to the looming shortage in the primary care workforce. A quicker and less costly approach to offset primary care physician shortages can occur with the workforce already in place, through efforts to reduce the widespread waste and inefficiency in the typical physician workday.

A study in the November issue of Health Affairs says modest but system-wide improvements could yield dramatic gains in physician capacity while potentially reducing physician burnout and its implications for quality of care.

“If widely adopted, small efforts to empower nonphysicians, reengineer workflows, exploit technology, and update policies to eliminate wasted effort could yield the capacity for millions of additional patient visits per year,” said Scott Shipman and Christine Sinsky in their study.

The need to improve primary care capacity is increasingly important with the implementation of the Affordable Care Act in 2014, when millions are expected to become newly insured. Policy researchers have estimated that insurance expansion will generate 15-24 million additional primary care visits each year.

Considerable attention has been placed on the costly and lengthy process of training more physicians to meet this demand. Instead, Drs. Shipman and Sinsky point out, the current workforce could be utilized more effectively, not by asking physicians to work harder but by making systems of care more efficient and focusing physicians’ time on activities warranting their expertise.

Straightforward efforts to reduce wasted time, adopted widely across the nation’s primary care physicians, could yield tremendous additional capacity. For instance, just 30 minutes of reduced waste per day - which the authors demonstrate can be readily achieved through efforts such as delegation of certain clerical tasks or improved clinic workflows - could result in 30-40 million more primary care visits available each year without a single additional provider.

Shipman, through his association with the Association of American Medical Colleges, and Sinsky, through hers with the American Board of Internal Medicine Foundation, suggest solutions to the “remarkable inefficiency” in primary care. The authors conducted nationwide site visits, contacted leaders of innovative primary care practices across the country and reviewed the literature.

The authors highlight several opportunities to improve efficiency in primary care through examples currently in use, albeit in a minority of settings:

Teamwork - Conservatively, research suggests that other staff members could perform tasks that consume 15 percent of the time physicians spend on patient care outside of visits. Enlisting health coaches, medical assistants or nurses to aid with documentation of office visits enables more time for physicians interact with patients, rather than keyboards and computer monitors. These team members could also review care plans, and provide preventive counseling and other standardized aspects of care.