Harvard Medical School, Boston, MA, USA.
Department of Medicine, Cambridge Health Alliance, Cambridge, MA, USA.
J Gen Intern Med. 2023 Feb;38(2):434-441. doi: 10.1007/s11606-022-07688-x. Epub 2022 Jun 6.
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.
To investigate trends and racial/ethnic disparities in the receipt of annual face time with physicians in the USA.
Repeated cross-sectional.
National Ambulatory Medical Care Survey, 1979-1981, 1985, 1989-2016, 2018.
Office-based physicians.
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.
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.
Self-reported visit length.
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.
医生的时间是一种宝贵而有限的资源。无论这段时间是否在人群亚组中公平分配，以及近几十年来这段时间的分配情况如何，目前都不清楚。
调查美国医生每年与患者面对面交流时间的趋势和种族/民族差异。
重复的横截面研究。
1979-1981 年、1985 年、1989-2016 年和 2018 年的全国门诊医疗调查。
门诊医生。
暴露因素包括种族/民族（白种人、黑种人和西班牙裔）、年龄（<18 岁、18-64 岁和 65 岁以上）和调查年份。我们的主要结局是患者每年与医生面对面交流的时间；次要结局包括每年就诊率和平均就诊时间。
我们的样本包括 1108835 例患者就诊。从 1979 年到 2018 年，人均门诊医生面对面交流时间从 40.0 分钟增加到 60.4 分钟，这一增长是由于平均就诊时间的延长而不是就诊次数的增加。然而，自 2005 年以来，初级保健医生的平均年度面对面交流时间有所下降，这一降幅被专科医生就诊时间的增加所抵消。由于医生劳动力的增长，每位医生提供的面对面交流时间变化不大。在研究开始时存在的医生就诊时间的种族/民族差距随着时间的推移而扩大。在 2014-2018 年期间，白人每年接受 70.0 分钟的医生面对面交流时间，而黑人则为 52.4 分钟，西班牙裔为 53.0 分钟。这种差异是由就诊率的差异而不是平均就诊时间的差异以及专科医生而不是初级保健医生的差异造成的。
就诊时间的自我报告。
自 1979 年以来的 30 年里，美国人每年与门诊医生面对面交流的时间增加了，但仍然分配不均，尤其是由专科医生造成的；与此同时，美国人与初级保健医生相处的时间正在减少。这些趋势和差异可能会对患者的治疗效果产生不利影响。需要政策的改变来确保这种资源的合理分配。
