Most people probably don't give much thought to their doctors' free time.
But how exactly do they manage busy patient loads and still have weekends and
vacations? The answer can affect you and your family's health and
Many physicians belong to a "coverage group": One physician
temporarily takes care of all of the group's patients. So from Friday evening
until Monday morning -- almost 40% of the hours in a week -- your medical care
may well be in the hands of a physician other than...
Question: What are some ways to know you've joined a cheap
Answer: To avoid a time-consuming throat culture, the doctor French kisses
And by now many web-browsing patients and doctors have seen the
widely circulated memo by a fictitious squinty-eyed claims administrator
offering a cost-effectiveness analysis of a famous unfinished Schubert
symphony: "If all redundant passages were eliminated, as determined by the
utilization review committee, the concert would have been reduced to about 20
minutes, resulting in substantial savings in salaries and overhead. In fact, if
Schubert had addressed these concerns on a cost-containment basis, he probably
would have been able to finish his symphony."
The jokes attest to a pervasive anxiety about the
transformations of American medical care in the last 20 years. And they speak
to the widespread belief -- disseminated as conventional wisdom -- that managed
care has drastically reduced the amount of time a physician can spend with a
But now national survey data have turned up a startling
finding: The average duration of physician office visits actually
increased between 1989 and 1998.
"It is important for patients to understand that the
rhetoric about managed care is not necessarily true," lead author David
Mechanic, PhD, director of the Institute on Health, Healthcare Policy, and
Aging Research at Rutgers University, tells WebMD. "They have to evaluate
their care on the basis of their own experience and on good data that is
Using information from two nationally representative data
banks, Mechanic found that the average duration of a physician office visit
increased between one and two minutes from 1989 to 1998. The length of office
visits increased for patients in both prepaid HMOs and non-prepaid managed care
plans, according to the report, published in the Jan. 18 issue of The New
England Journal of Medicine.
How is it possible that such widely received wisdom can be
stood on its head?
Mechanic, who says he himself initially accepted the
conventional wisdom, believes the popular media is a culprit, peddling
anecdotes about managed care horror stories based on isolated patient
experiences without objective confirmation.
In fact, he says, objective data reveal great variability among
managed care companies. "We get fixated on anecdotally built theories that
divert us from the really important policy issues of access to health
insurance, appropriate ways of organizing long-term and chronic care, and
quality of care," he says.
And Mechanic suggests that because of the backlash against
managed care, many managed care organizations are increasingly focused on
patient satisfaction. "Doctors know that a key to patient satisfaction is
the time they spend with them," he says.