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Trends and Disparities in the Distribution of Outpatient Physicians’ Annual Face Time with Patients, 1979–2018

Journal of General Internal Medicine volume 38, pages 434–441 (2023)Cite this article

Abstract

Background

Physician time is a valuable yet finite resource. Whether such time is apportioned equitably among population subgroups, and how the provision of that time has changed in recent decades, is unclear.

Objective

To investigate trends and racial/ethnic disparities in the receipt of annual face time with physicians in the USA.

Design

Repeated cross-sectional.

Setting

National Ambulatory Medical Care Survey, 1979–1981, 1985, 1989–2016, 2018.

Participants

Office-based physicians.

Measures

Exposures included race/ethnicity (White, Black, and Hispanic); age (<18, 18–64, and 65+); and survey year. Our main outcome was patients’ annual visit face time with a physician; secondary outcomes include annual visit rates and mean visit duration.

Results

Our sample included n=1,108,835 patient visits. From 1979 to 2018, annual outpatient physician face time per capita rose from 40.0 to 60.4 min, an increase driven by a rise in mean visit length and not in the number of visits. However, since 2005, mean annual face time with a primary care physician has fallen, a decline offset by rising time with specialists. Face time provided per physician changed little given growth in the physician workforce. A racial/ethnic gap in physician visit time present at the beginning of the study period widened over time. In 2014–2018, White individuals received 70.0 min of physician face time per year, vs. 52.4 among Black and 53.0 among Hispanic individuals. This disparity was driven by differences in visit rates, not mean visit length, and in the provision of specialist but not primary care.

Limitation

Self-reported visit length.

Conclusion

Americans’ annual face time with office-based physicians rose for three decades after 1979, yet is still allocated inequitably, particularly by specialists; meanwhile, time spent by Americans with primary care physicians is falling. These trends and disparities may adversely affect patient outcomes. Policy change is needed to assure better allocation of this resource.

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Author information

Authors and Affiliations

  1. Harvard Medical School, Boston, MA, USA

    Adam Gaffney MD, MPH, David U. Himmelstein MD, Danny McCormick MD MPH & Steffie Woolhandler MD MPH

  2. Department of Medicine, Cambridge Health Alliance, Cambridge, MA, USA

    Adam Gaffney MD, MPH, David U. Himmelstein MD, Danny McCormick MD MPH & Steffie Woolhandler MD MPH

  3. Hunter College, City University of New York, New York, NY, USA

    David U. Himmelstein MD & Steffie Woolhandler MD MPH

  4. Public Citizen Health Research Group, Washington, DC, USA

    David U. Himmelstein MD & Steffie Woolhandler MD MPH

  5. Planned Parenthood South Texas, San Antonio, TX, USA

    Samuel Dickman MD

  6. Brigham and Women’s Hospital, Boston, MA, USA

    Christopher Cai MD

Authors
  1. Adam Gaffney MD, MPH
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  2. David U. Himmelstein MD
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Corresponding author

Correspondence to Adam Gaffney MD, MPH.

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Conflict of Interest

Adam Gaffney, David Himmelstein, Steffie Woolhandler, Chris Cai, and Danny McCormick are, or have served as, leaders of Physicians for a National Health Program (PNHP), a non-profit organization that favors coverage expansion through a single payer program; however, none of them receive any compensation from that group, although some of Dr. Gaffney’s travel on behalf of the organization has been reimbursed by it. The spouse of Adam Gaffney is an employee of Treatment Action Group (TAG), a non-profit research and policy think tank focused on HIV, TB, and Hepatitis C treatment. In 2020, Chris Cai worked as a paid policy intern to US Representative Pramila Jayapal.

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Gaffney, A., Himmelstein, D.U., Dickman, S. et al. Trends and Disparities in the Distribution of Outpatient Physicians’ Annual Face Time with Patients, 1979–2018. J GEN INTERN MED 38, 434–441 (2023). https://doi.org/10.1007/s11606-022-07688-x

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  • DOI: https://doi.org/10.1007/s11606-022-07688-x