Effect of part-time practice on patient outcomes.
BACKGROUND
Primary care physicians are spending fewer hours in direct patient care, yet it is not known whether reduced hours are associated with differences in patient outcomes.


OBJECTIVE
To determine whether patient outcomes vary with physicians' clinic hours.


METHODS
Cross-sectional retrospective design assessing primary care practices in 1998.


METHODS
All 25 outpatient-clinics of a single medical group in western Washington.


METHODS
One hundred ninety-four family practitioners and general internists, 80% of whom were part-time, who provided ambulatory primary care services to specified HMO patient panels. Physician appointment hours ranged from 10 to 35 per week (30% to 100% of full time).


METHODS
Twenty-three measures of individual primary care physician performance collected in an administrative database were aggregated into 4 outcome measures: cancer screening, diabetic management, patient satisfaction, and ambulatory costs. Multivariate regression on each of the 4 outcomes controlled for characteristics of physicians (administrative role, gender, seniority) and patient panels (size, case mix, age, gender).


RESULTS
While the effects were small, part-time physicians had significantly higher rates for cancer screening (4% higher, P =.001), diabetic management (3% higher, P =.033), and for patient satisfaction (3% higher, P =.035). After controlling for potential confounders, there was no significant association with patient satisfaction (P =.212) or ambulatory costs (P =.323).


CONCLUSIONS
Primary care physicians working fewer clinical hours were associated with higher quality performance than were physicians working longer hours, but with patient satisfaction and ambulatory costs similar to those of physicians working longer hours. The trend toward part-time clinical practice by primary care physicians may occur without harm to patient outcomes.
Parkerton
Patricia H
PH
Department of Health Services, UCLA School of Public Health, University of California at Los Angeles, Box 91772, Los Angeles, CA 90095-1772, USA. parkert@ucla.edu
Wagner
Edward H
EH
Smith
Dean G
DG
Straley
Hugh L
HL
D000328:Adult; D003430:Cross-Sectional Studies; D005260:Female; D006279:Health Maintenance Organizations; D006801:Humans; D008297:Male; D015999:Multivariate Analysis; D017063:Outcome Assessment, Health Care; D017060:Patient Satisfaction; D010561:Personnel Staffing and Scheduling; D011320:Primary Health Care; D011787:Quality of Health Care; D013996:Time and Motion Studies; D014861:Washington; D000078329:Workforce