When internist Richard Baron was invited to give a talk about what's happening in primary care, he had an idea: Why not count up exactly how many patient visits, phone calls and e-mails he and his four associates handle in a year?
Thanks to the electronic health record system his practice uses to store, retrieve and manage patient information, the task was not as herculean as it would have been in the old days.
But the totals took even Baron aback. In 2008, he and his associates each handled an average of 20 phone calls and 17 e-mails a day. That's on top of an average of three to six hours a day spent on patient visits.
"Even though I've been doing this for 20 years, this is really a surprise," Baron, who reports his findings today in The New England Journal of Medicine, said in an interview.
Though his practice cares for a socioeconomically diverse patient population of about 8,500 in Philadelphia's Mount Airy neighborhood, Baron says, "I certainly believe the demands and the activities we describe in the article are absolutely typical" of all primary care practices.
No wonder only 2% of today's medical school graduates say they want to pursue careers as internists who provide primary care, says Baron, who chaired the American Board of Internal Medicine last year.
"What we're reporting on is what I call patient-initiated demand," he says. "That's people reaching out to us for stuff. We don't charge for any of these services."
Yet, he says, phone calls and e-mail are a key part of primary care today. Baron's message to health care policymakers and payers: "The way you pay us doesn't work for the work we actually need to do."
Billing for every phone call and e-mail would be impractical, he says, but getting paid an annual lump sum per patient, a system called capitation, would help cover the time primary care doctors spend on patients.
Jeffrey Farber, an assistant professor in the department of geriatrics and palliative medicine at the Mount Sinai School of Medicine in New York, took a similar look at his practice in three random, one-week periods.
In a 2007 paper in the Annals of Internal Medicine, Farber and his co-authors estimated that a full-time geriatrician, an internist who completes one or two years of extra training in caring for elderly patients, spends about eight hours a week on patient care outside of office visits.
The problem, Farber says, is "the reimbursement system was really designed in an era where we were treating acute illnesses. It pays for the face-to-face office visit and nothing else."
To see more of USAToday.com, or to subscribe, go to http://www.usatoday.com
Copyright 2009 USA TODAY, a division of Gannett Co. Inc.