Study: U.S. Patients' Exposure to Primary Care Lags Behind Others'

Americans have less "face time" with their primary care physicians than patients in Australia or New Zealand, a situation that "may have real consequences in terms of preventive care and management of chronic conditions" and "could partially explain why the US does not have health outcomes that correspond to its overall investment in health care."

Those were the findings and conclusions of Andrew Bindman, M.D., professor of internal medicine at the University of California, San Francisco, and his research colleagues in "Diagnostic Scope of and Exposure to Primary Care Physicians in Australia, New Zealand, and the United States," in the June 16 BMJ.

Bindman and his colleagues compared 2001-2002 survey data from the three nations and found Americans spend an average of 29.7 minutes per year with a primary care physician, compared with 55.5 minutes for New Zealanders and 83.4 minutes for Australians.

To receive adequate preventive care, children should see a primary care physician an average of 37 minutes each year, and adults should see a primary care physician an average of 40 minutes per year, according to the U.S. Preventive Services Task Force. The U.S. average, therefore, fails to meet those recommended levels, say Bindman and his colleagues.

"Not only does the time demand for (preventive) services exceed the annual time available to the average American in primary care, it does not consider the average additional need of 20 to 40 minutes a year for each chronic condition a person may have," the researchers write. "More than half of U.S. primary care physicians' time is spent on the management of acute conditions, and this role further limits their capacity to meet the prevention and chronic care needs of their patients."

Although physicians in all three countries saw similar numbers of patients per day and managed similar numbers of health problems per patient visit, the research found that American primary care physicians spend an average of 10 percent more time in each patient visit. However, Americans pay fewer visits to their primary care physicians, thus accounting for the lower overall exposure time observed.

The authors speculate that a smaller scope of practice and greater use of subspecialists contribute to the comparatively fewer primary care visits.

"The finding that the range (of clinical work) is narrower in the United States than in Australia and New Zealand … also suggests that the comprehensiveness of primary care is influenced at the margin by the amount of specialization in the health care system," Bindman and his co-authors write. "The use of specialists is greater in the United States than in either Australia or New Zealand. The high proportion of specialist physicians in the United States, in combination with the ability of patients to self-refer for specialty services, results in some patients seeing only specialists in ambulatory care services. Our results expand these findings to suggest that the availability of specialist physicians might also contribute to defining the range of problems managed in primary care."

The researchers conclude, "The severe shortfall of available time in primary care for prevention and chronic care management in the United States could partially explain why the United States does not have health outcomes that correspond to its overall investment in health care."