How much time do physicians spend providing care outside of office visits?

Background: People with chronic illness require care outside of office visits, much of which is not reimbursed under current Medicare guidelines. Objective: To describe the amount of time geriatricians spend and the nature of care they provide outside of office visits. Design: Cross-sectional study on the time spent by physicians in clinical interactions outside of patient visits during 3 randomly sampled, 1-week periods. Setting: An academic geriatric medicine ambulatory practice. Participants: 16 physicians. Measurements: Information on the method, content, outcome, and participants in clinical interactions outside of office visits was collected on a structured form. Results: There were 472 discrete interactions, representing 296 episodes of care for 226 patients. Fifty-four percent of interactions were linked as multistep episodes, whose mean duration (range; 25th, 75th percentiles) was 18.9 minutes (3 to 70 minutes; 9, 21 minutes). Thirty-six percent of episodes involving a new medical symptom resulted in medication use, 27% resulted in an office visit, and 9% resulted in a referral to another physician. Mean time spent per physician per week was 112.2 minutes (range, 36 to 260 minutes), which represents an additional 6.7 minutes (range, 1.7 to 13.8) of care provided outside of office visits for every 30 minutes of time spent scheduled to see ambulatory patients. For a full-time physician scheduled to see 14 patients per day in 30-minute visits over a 5-day workweek, this would represent an extra 7.8 hours of clinical work per week. Limitation: Data were self-reported and were limited to an academic geriatric medicine practice. Conclusion: Physicians spend a considerable amount of time providing care outside of office visits for patients with chronic illness. This study suggests that collecting empirical data on the amount and nature of nonreimbursed care activities is feasible and should be done in more generalizable settings to inform debates about reimbursement reform.