Managed care lengthens physician visits

An article in the New England Journal of Medicine (vol. 344, no. 3) asserts that the increased penetration of managed care organizations actually increases the amount of time patients spend with their doctors. The article debunks most physicians' perception that managed care limits the time they have to spend with their patients.

The authors of the article looked at data from the National Ambulatory Medical Care Survey and the American Medical Association's Socioeconomic Monitoring System to determine the lengths of office visits for prepaid (health plan) and non-prepaid visits for primary and specialty care, for new and established patients, and for common and serious diagnoses. The data revealed that between 1989 and 1998, the mean length of office visits increased from 16.4 minutes to 18.5 minutes for non-prepaid visits, and from 15.4 minutes to 17.9 minutes for prepaid visits. There was also an increase in the length of office visits for primary and specialty care, in addition to new and established patients. The length of office visits for patients with the most common diagnoses and more serious diagnoses, however, remained stable.

Perception vs. reality

In an editorial accompanying the article, Edward Campion speculates that the reason physicians perceive that they have less time to see patients is that they actually have more to do because of managed care. "The sense of not having enough time should be understood as a reflection of the wider problems and pressures that physicians face," he wrote. "The misperceptions about the length of office visits may be a symptom of physicians' discontent with the system. Currently, there is a tendency to point to managed care as the cause of nearly every problem we see. Although managed care has grown and is disruptive, most patients still have traditional insurance coverage. The reasons for physicians' discontent go beyond the problems that come with managed care. Office visits seem short because there is more to do, more to think about and more that is expected." PR