Newly Insured May Strain Provider-Patient Relationships

Published Online: April 21, 2014
Katie Sullivan, MA
The relationship between a doctor and a patient can be one of the most important components to ensuring that they receive the best care possible. However, recent findings suggest that appointment windows still average only 15 minutes, and that doesn’t provide patients with much time for care. Additionally, many experts worry that as the number of insured increases, this window may be even further strained and that it could drastically affect patients’ quality of care.

“Doctors have one eye on the patient and one eye on the clock,” said David Rothman, PhD, who studies the history of medicine at Columbia University’s College of Physicians and Surgeons.

While many physicians dislike the current fee-for-service model that exists in primary care, it is hard to avoid because they are reimbursed for volume, not value. This leads many to rushing patients out the door with a prescription instead of discussing lifestyle changes that would improve their health. One such example might be encouraging a patient to lose weight through a diet regimen.

“Doctors are thinking, ‘I have to meet my bottom line, pay my overhead, pay my staff, and keep my doors open. So it’s a hamster wheel, and they’re seeing more and more patients,” said Reid Blackwelder, MD, FAAFP, president of the American Academy of Family Physicians. “And what ends up happening is the 15-minute visit.”

Alex Lickerman, MD, an internist at the University of Chicago, added that while patients may have a laundry list of issues they’d like to discuss after waiting for an appointment for several months, the doctor has the 15-minute appointment limit in mind—and this can build tension between a doctor and patient.

“People feel dissatisfied when they don’t get a chance to say what they have to say,” said Dr Lickerman. “I will sometimes boast that I can make people feel they ‘got their money’s worth’ in 5 minutes. It’s not the actual time or lack of time people are complaining about—it’s how that time felt.”

The 15-minute time window is said to be a product of Medicare’s adoption of a byzantine formula in the early 1990s. The payment formula relies on “relative value units” to determine doctors’ fees. The American Medical Association suggested a 15-minute consult based on findings that suggested the average primary care patient had 1.3 relative value units, also referred to as RVUs.

Around the Web

15-Minute Visits Take A Toll On The Doctor-Patient Relationship [Kaiser Health News]