title: Expanding primary care capacity by reducing waste and improving the efficiency of care.
abstract: Most solutions proposed for the looming shortage of primary care physicians entail strategies that fall into one of three categories: train more, lose fewer, or find someone else. A fourth strategy deserves more attention: waste less. This article examines the remarkable inefficiency and waste in primary care today and highlights practices that have addressed these problems. For example, delegating certain administrative tasks such as managing task lists in the electronic health record can give physicians more time to see additional patients. Flow managers who guide physicians from task to task throughout the clinical day have been shown to improve physicians' efficiency and capacity. Even something as simple as placing a printer in every exam room can save each physician twenty minutes per day. Modest but systemwide improvements could yield dramatic gains in physician capacity while potentially reducing physician burnout and its implications for the quality of care. If widely adopted, small efforts to empower nonphysicians, reengineer workflows, exploit technology, and update policies to eliminate wasted effort could yield the capacity for millions of additional patient visits per year in the United States.
authors.forename: Scott A
authors.initials: SA
authors.lastname: Shipman
authors.forename: Christine A
authors.initials: CA
authors.lastname: Sinsky
mesh_terms: D017598:Efficiency, Organizational; D057286:Electronic Health Records; D006291:Health Policy; D006297:Health Services Accessibility; D006801:Humans; D007587:Job Description; D058991:Patient Protection and Affordable Care Act; D058007:Physicians, Primary Care / Q000600:supply & distribution*; D011320:Primary Health Care / Q000458:organization & administration*; D013996:Time and Motion Studies; D014481:United States; D000078329:Workforce
keywords: Access To Care; Organization And Delivery Of Care; Physicians; Primary Care; Workforce Issues