In a health care environment that emphasizes precise figures and measurable data, the inability to pin down an exact and appropriate primary care practice patient panel size is not only ironic -- it further confounds efforts to accurately forecast physician workforce needs.
A figure of 2,500 patients per physician is often cited as typical, but researchers at the Robert Graham Center for Policy Studies in Family Medicine and Primary Care recently revealed that number to be more fiction than fact, with no reliable evidence to back it up. Now that physicians are being asked to catalogue and report on their entire patient population, identifying an accurate patient panel size is more important than ever before.
In their article "A Primary Care Panel Size of 2500 Is Neither Accurate nor Reasonable,"(www.jabfm.org) Graham Center researchers break down the origins of the mythical figure. The article was published in the July-August issue of the Journal of the American Board of Family Medicine (JABFM).
Researchers trace the 2,500 figure to a single sentence in an article written in 2000 that was not based on any sort of rigid statistical analysis. Given that family physicians, on average, report addressing three problems during each patient visit, it would take 21.7 hours each day to provide recommended care to a patient panel of 2,500 -- an obvious impossibility.
- A patient panel size of 2,500 is often cited as typical, but researchers at the Robert Graham Center for Policy Studies in Family Medicine and Primary Care revealed that number to be more fiction than fact.
- A more accurate accounting of panel size would assist researchers and policy makers when estimating primary care shortages and preparing for value-based payment models.
- Research indicates that a smaller panel size and effective team-based care yield greater patient and physician satisfaction and better health outcomes.
"Multiple studies observed that a panel size of 2,500 is not feasible because of time constraints and results in incomplete preventive care and health care screening services," the authors of the JABFM article write.
In practices with smaller panels, patients experience shorter waiting periods for appointments, longer visits and improved quality of care.
According to a previous study(jabfm.org) cited by the Graham Center researchers, only one-third of family physicians are able to correctly estimate their patient panel size. A more accurate accounting of panel size would assist researchers and policymakers when estimating primary care shortages and preparing for the transition to value-based payment models.
"When trying to project the primary care shortage, a lot of research models assume that a physician has 2,500 patients, which is not accurate," said Miranda Moore, Ph.D., a Graham Center researcher and co-author of the study. "If the models used a more accurate panel size, they would show a need for a lot more physicians and the shortage would be much larger."
As an example, Moore said that one model showed that if the patient panel size were decreased by 10 percent, the projected shortage of primary care physicians would increase by 27,000 physicians.
Average patient panel size varies widely based on multiple factors, such as patient demographics, physician preferences, and practice finances and infrastructure, according to the study authors.
Kaiser Permanente, for example, one of the nation's largest physician networks, reports an average panel size of 1,751 patients per physician. Group Health Cooperative of Puget Sound, which serves more than 600,000 patients in Washington and northern Idaho, claims a panel size of 1,490 patients per physician, and the Department of Veterans Affairs reports an average of 1,266 patients per full-time physician. Physicians who operate in a concierge or boutique model, on the other hand, typically care for between 900 and 1,000 patients.
"What physicians want aligns with what patients want: improved patient access and continuity of care," the Graham Center researchers write, noting that in practices with smaller panels, patients experience shorter waiting periods for an appointment, longer visits and improved quality of care. "Case studies have shown that panel sizes less than 2,500 and effective team pairing yield greater patient and physician satisfaction and better health outcomes."
But Moore cautioned that even if an appropriate number could be estimated, it would not entirely account for physician demographics, and it would not address the burgeoning volume of patients with comorbidities.
"I don't think there is a need for a specific benchmark, but there is a need to reconcile what we think of as an appropriate panel size, and it should be lower than 2,500," she said.
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