Trade-offs in high-volume primary care practice

Stephen J. Zyzanski, Kurt C. Stange, Doreen Langa, Sue Flocke

Research output: Contribution to journalArticle

83 Citations (Scopus)

Abstract

Background. With today's emphasis on reducing costs and increasing efficiency, primary care physicians are under pressure to increase patient volume. This study was undertaken to (1) identify factors associated with differences in physician volume, and (2) test for differences in selected clinical outcomes and time use during patient visits. Methods. Research nurses directly observed consecutive patient visits during 2 separate days in the offices of 108 community family physicians. Data on the content of 3893 outpatient visits were collected using direct observation, patient and physician questionnaires, and medical record review. Physicians with high-, medium-, and low-volume practices were compared in the rates of preventive services delivery, patient satisfaction, and time use during patient visits as measured with the Davis Observation Code. Results. High-volume physicians had visits that were 30% shorter, scheduled one third fewer patients for well care, and were more likely to own their practice and to be male than were low-volume physicians. Time use during patient visits was remarkably similar for high- and low-volume physicians. However, after controlling for relevant patient characteristics, patients of high-volume physicians had lower up-to- date rates of preventive services and scored lower on measures of satisfaction and the doctor-patient relationship. Conclusions. Physicians with high-volume practices are more efficient than those with low-volume practices in providing similar services in a shorter amount of time. This greater apparent efficiency may come at a cost of lower rates of preventive services delivery, lower patient satisfaction, and a less positive doctor- patient relationship. Health care plans and physicians setting productivity goals should consider the trade-offs inherent in high-volume practice.

Original languageEnglish (US)
Pages (from-to)397-402
Number of pages6
JournalJournal of Family Practice
Volume46
Issue number5
StatePublished - May 1 1998
Externally publishedYes

Fingerprint

Primary Health Care
Physicians
Patient Satisfaction
Observation
Costs and Cost Analysis
Family Physicians
Primary Care Physicians
Medical Records
Patient Care
Outpatients
Nurses
Delivery of Health Care
Pressure
Research

Keywords

  • Doctor-patient relationships
  • Patient satisfaction
  • Physician's practice characteristics
  • Physicians, family

ASJC Scopus subject areas

  • Family Practice

Cite this

Zyzanski, S. J., Stange, K. C., Langa, D., & Flocke, S. (1998). Trade-offs in high-volume primary care practice. Journal of Family Practice, 46(5), 397-402.

Trade-offs in high-volume primary care practice. / Zyzanski, Stephen J.; Stange, Kurt C.; Langa, Doreen; Flocke, Sue.

In: Journal of Family Practice, Vol. 46, No. 5, 01.05.1998, p. 397-402.

Research output: Contribution to journalArticle

Zyzanski, SJ, Stange, KC, Langa, D & Flocke, S 1998, 'Trade-offs in high-volume primary care practice', Journal of Family Practice, vol. 46, no. 5, pp. 397-402.
Zyzanski SJ, Stange KC, Langa D, Flocke S. Trade-offs in high-volume primary care practice. Journal of Family Practice. 1998 May 1;46(5):397-402.
Zyzanski, Stephen J. ; Stange, Kurt C. ; Langa, Doreen ; Flocke, Sue. / Trade-offs in high-volume primary care practice. In: Journal of Family Practice. 1998 ; Vol. 46, No. 5. pp. 397-402.
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