Primary care physician productivity: the physician factor.
OBJECTIVE
To model physician productivity as a function of clinic (support system) characteristics and physician characteristics and to model the time a physician spends with the patient as a function of patient characteristics.


METHODS
Observational study.


METHODS
A general medicine clinic of a university-affiliated Veterans Affairs medical center.


METHODS
A cohort of 2,520 patients having 2,721 consecutive outpatient visits to 56 physicians.


METHODS
Physician productivity defined as patients seen/physician/hour and time (minutes) spent with the patient.


RESULTS
Physicians saw a mean (+/- SD) of 1.62 +/- 0.68 patients/hour. Clinic characteristics explained 8.2% of the variability of session-specific physician productivity. Controlling for clinic characteristics, a factor representing the physician explained an additional 55.4%. A model for overall physician productivity, using physician characteristics, explained 84.9% of the variance, and time spent with the patient was an important predictor. Modeling physician time with patients, patient characteristics accounted for only 7% of the variability. Controlling for patient characteristics, the individual physician again provided the greatest explanatory power, an additional 22.8% of the variability.


CONCLUSIONS
Physicians' practice patterns, rather than clinic or patient characteristics, may account for most of the variation in physician productivity. Given the magnitude of the influence of individual practice patterns, interventions to increase productivity need to consider methods to affect physician behavior.
Smith
D M
DM
Division of General Medicine, Richard L. Roudebush VAMC, Indianapolis, IN 46202, USA.
Martin
D K
DK
Langefeld
C D
CD
Miller
M E
ME
Freedman
J A
JA
D001071:Appointments and Schedules; D004526:Efficiency; D007196:Indiana; D015233:Models, Statistical; D009819:Office Visits; D010045:Outpatients / Q000706:statistics & numerical data; D010821:Physicians, Family / Q000706:statistics & numerical data*; D011216:Practice Management, Medical; D013996:Time and Motion Studies; D014481:United States