Physician style and HMO affiliation impact lengths of patient visit

Dec 5 2007

Apart from a more complicated medical case, what makes different physicians spend different amounts of time with their patients" Researchers at UC Davis have identified several key doctor- and practice-specific characteristics that affect the length of a patient's medical appointment, and ultimately with a patient's satisfaction with the doctor's visit.

In a new study, "Primary Care Visit Length, Quality, and Satisfaction for Standardized Patients with Depression" in the December 2007 issue of the Journal of General Internal Medicine, Estella Geraghty and her colleagues found several key determinants for visit length, ranging from individual style and practice volume to whether a physician practiced within a health maintenance organization (HMO) or whether the doctor had any nonprofessional experience with depression.

Identifying the key predictors that drive the length of doctor visits has long remained elusive, despite much effort by researchers. Using what are called "standardized patients" -- actors who have been carefully coached to simulate specific patient ailments -- Geraghty and her team were able to control patient presentations and more accurately gauge physician practices.

Researchers found that visit length for patients with similar conditions varied more than 10-fold among primary care physicians, with much of the variation attributed to individual physician styles. Doctors working in HMOs and those with the busiest schedules, for example, spent significantly less time with patients. Physicians with personal or vicarious experience with depression, however, spent more time with their patients. They spent as much as 11 percent more time with depressed patients than doctors who did not have that connection with the ailment.

The study found that despite using standardized patients to control for variability in cases, visit times still ranged significantly, from about six minutes to more than 72 minutes, with an average visit lasting approximately 22 minutes.

Geraghty, an assistant professor of clinical internal medicine at UC Davis, pointed out that meeting patients' desires for longer visits tends to conflict with the pressures faced by most physicians in established practices.

"Physicians who work in HMOs or who have busy practices risk jeopardizing patient satisfaction because, inevitably, their patient visits are shorter," she said. "Patient satisfaction is an important component of care because it influences a patient's adherence to a physician's recommended plan for treatment. Consequently, there is a constant tension between practice efficiency and providing a long enough visit to satisfy the patient."

Geraghty noted that it could be important for doctors who can't easily carve out more time for consultations with their patients to find alternative ways to improve patient satisfaction. She said small steps, such as exhibiting greater empathy, enhancing active listening skills, decreasing waiting-room time, asking more open-ended questions about primary complaints and allowing patients to respond with minimal interruption could help compensate for unavoidably short visit lengths.

The study involved 298 primary care visits by 18 standardized patients to physicians at medical offices in California and New York. Standardized patients are healthy persons trained to portray the personal history, physical symptoms, emotional characteristics and everyday concerns of an actual patient. Using these actor-patients helped Geraghty and her colleagues limit the uncontrolled variability associated with patient differences encountered when using real-life patients.

The researchers concluded that more study is needed to examine the relationship of quality and visit length and to understand how physicians can maximize patient satisfaction within a reasonable amount of time.