It was almost 15 years ago that I set my personal record, since equaled but never exceeded, of 18 patients seen in the course of a single afternoon. What I remember are not the details of that particular day — all days are hectic for one reason or another — but a conversation I had at a party a short time later.
With nothing much else to discuss with another guest, also a doctor, I modestly mentioned my record. He smiled indulgently and replied that he averaged more like 60 primary-care visits a day.
For some time afterward, I compulsively redid the math (he spent around eight minutes per patient, hour after hour) and idly fantasized about his office, which clearly included a small army of medical assistants, other capable souls to handle phone, fax and paperwork, and extraordinary data-retrieval abilities for labs and tests. And a lot of agreeably healthy patients. Or maybe they were too sick to talk much. Did the man eat? I wondered. Did he type? Perhaps a court reporter stood by.
Of course, when I heard a few years later that the state had closed his office and stripped him of his medical license, a whole new set of images came to mind.
I am hardly alone in these fantasies: Every medical administrator in the country has the same obsession with physician productivity, from the happy daydreams of smooth high-throttle operation to the nightmares of wipeout if the machine spins out of control.
For some medical metrics, the sky's the limit — we aim for zero complication rates, 100 percent adherence to various required annual screens. But performance statistics always come with a natural cap. The cheetah maxes out at 60 miles per hour or so, and no American cow has yet provided more than 7,000 gallons of milk a year. How fast, then, can a domestic physician move? How much health can one produce?
Everybody approaches the math a little differently, wielding different units of measurement. Some think only in dollars, with yearly income goals that are self-imposed or set by an employer. The less said about them the better.
A more legitimate unit of productivity is the number of patients in a doctor's practice — the patient panel, to use the technical term. American primary care providers have long been estimated to work smoothly if they care for about 2,300 patients each, at an average rate of 3.3 visits a year, which works out to 25 visits a day, including Saturdays.
Some authorities now worry this number may be much too high. Even without factoring in the exploding paperwork, the list of tasks each patient brings to the office is growing with body mass. The average American general practitioner is now estimated to worry about a total of 417 cases of uncontrolled cholesterol, 312 cases of uncontrolled high blood pressure, 91 cases of uncontrolled diabetes, a few hundred of these same problems under good control and then a variety of other chronic illness in various states of disarray.
