Are Shorter Doctors' Visits Just a Myth?

Jan. 17, 2001 -- The frustrations -- real or perceived -- confronting patients and doctors by managed care have provided comedians with material for a month of stand-up routines:

Question: What do you call a visit to an HMO doctor for a flu shot?
Answer: A drive-by shooting.

Question: What are some ways to know you've joined a cheap HMO?
Answer: To avoid a time-consuming throat culture, the doctor French kisses you.

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 patient.

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 increasingly available."

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.