Doctors pack a lot more into 15 minutes than they used to
If the nation’s productivity has faltered in recent years it is not because of doctors, according to a major study of general practice work released today.
The well-regarded Bettering the Evaluation and Care of Health (BEACH) program has found that general practitioners are fitting much more into their consultations than they were 10 years ago even though the time spent with each patient has remained virtually unchanged.
People are going to see their GP more often, and are presenting with a wider number of complaints, particularly regarding the management of chronic conditions such as diabetes, hypertension, lipid disorders and depression.
In the 10 years to 2011-12 the number of problems GPs managed leapt from 145 per 100 patient encounters to 154 per 100, the BEACH figures show, suggesting that last financial year doctors collectively treated 48 million more problems than they did a decade earlier.
“We are seeing our GPs more often than we were a decade ago, and the GPs are also fitting more and more into their consultations,” BEACH program director, Associate Professor Helena Britt, said. “For example, patients are presenting with more issues, GPs are managing more problems, and doing more tests and procedures – yet the time spent in the average consultation has stayed steady at about 15 minutes.”
Associate Professor Britt said this was being achieved despite doctors cutting back on their hours.
BEACH data, drawn from 9802 participating GPs, shows that in the last 10 years the proportion of doctors working between 20 and 40 hours a week has climbed from 42 per cent to 53 per cent, while those working for between 41 and 60 hours a week has dropped from 43 to 32 per cent, and the proportion labouring for more than 60 hours a week has collapsed, from 4 to 1 per cent.
Associate Professor Britt admitted it was difficult to explain exactly how doctors were fitting more into their consultations, but speculated that improvements in managing chronic conditions and the increasing workload of practice nurses might be part of the answer.
“GPs are managing more chronic conditions overall, but there are perhaps a lot of people for whom they are well-controlled so consultations do not have to be as long,” she said. “Practice nurses are doing an increasing number of procedures, and that is freeing up time.”
The BEACH data shows that practice nurses conducted more that a third of all procedures in 2011-12.
The data hint at other areas where doctors may be saving time. In the last decade there has been a marked decline in the number of prescriptions with four or fewer repeats, and a significant increase in the proportion issued with five repeats – which now make up more than a third of all prescriptions issued.
Another potential time saver has been increased use of referrals. Ten years ago a little less than 8 per cent of problems managed by GPs involved referral to another health provider – this jumped to well above 9 per cent last financial year.
The biggest increases in referrals have been to psychologists, podiatrists, dieticians and dentists.
Associate Professor Britt said there was also evidence that GPs were spending less time advising their patients on diet and exercise, but it was not known whether practice nurses were picking up this work instead.
AR
