Volume and time

A commenter wrote yesterday that GPs in GB make $200 k and see 44 patients each day.  I do not have a source to verify that statement, but if true I do not see how it impacts our current debate.  As I have written many times, the biggest problem in providing excellent quality health care comes from not having enough time.  44 patients represents at least 5 patients each hour.  This rate is a recipe for lousy care.

We need our physicians to spend more time with each patient, not less.  The question here is one of value.  How much do you and should you value your physician’s time?  I will pick an arbitrary number here and say that a generalist is worth $100 per hour.  If you work 50 weeks at 8 hours each day that comes to $200 k.  Now the cost will be higher because we have to pay overhead (as much as 60-70% in many practices these days.)  We could decrease overhead if we just paid for time, without bureaucratic nonsense.

Paying for time would include the time for reviewing the chart, reviewing the lab tests, talking to you on the phone, and responding to your emails.  Alternatively, we could go with the retainer model and just pay a lump sum for the entire package.

Increasing volume is the solution that too many physicians take in order to increase income.  We can all understand why they take shortcuts, refer more quickly and go to expensive testing more quickly.  Our system does not penalize them for these indiscretions, in fact it rewards them by allowing them to increase volume.

Paying on volume leads to many perverse incentives.  Clearly volume is important.  We should develop true benchmarks of the ideal volume for different specialties (including adjustments for complexity.)

So I reject the comment (as did a later commenter.)  We probably should strive for outpatient generalists to see around 16 patients each day and inpatient generalists to follow approximately the same number.  This would allow the generalist to spend adequate time with each patient.  This would allow the generalist to spend some time thinking and reading about their problems.  This would increase patient satisfaction, quality of care and physician job satisfaction.