A new study funded by the AAN and several other medical associations suggests the work intensity of physicians across several specialties is fairly equal. The findings provide the groundwork for the development of a more reliable, scientific measurement of physician work intensity that may guide future national policy in patient safety, practice management and payment. The study was published online ahead of print in the journal Medical Care.
Results of the two-phase study represent the physician work intensity associated with the actual patient care of 108 neurologists, family physicians, general internists and surgeons in the southeast United States.
Researchers used the National Aeronautic and Space Administration-Task Load Index, Subjective Work Assessment Technique, Multiple Resource Questionnaire and the Dundee Stress Questionnaire to determine work intensity, which encompasses the time, mental effort and judgment, technical skill, physician effort and psychological stress it takes to care for a patient. Physicians responded to questionnaires immediately following a face-to-face patient visit or immediately after completing a surgical procedure.
Overall, specialties reported similar levels of work intensity; however, the specific dimensions of work intensity were more variable. Physical demand was particularly important for surgeons, while demands on time were more problematic for family physicians.
Researchers say the study points toward a more direct and complementary method of estimating physician work intensity that may guide a future, more precise valuation of intensity.
"The findings of this and other studies suggest that the instruments can be utilized in further investigation of clinical work intensity and that currently accepted assumptions of grossly differing work intensity among medical specialists may be flawed," said study author Jerzy P. Szaflarski, MD, PhD, FAAN, an associate professor of neurology at the University of Cincinnati College of Medicine. "These possibly incorrect assumptions have contributed to the development of current inequalities in relative value unit (RVU) distribution for procedures and evaluation and management (E/M) services. We hope that work in this direction will inform policy decisions, which now pay more for procedures than for the same amount of time a doctor spends talking with a patient. This type of face-to-face (non-procedural) care is provided by primary care physicians as well as non-procedural specialists. Further, larger scale study of this issue is sorely needed."
The study was supported by the AAN, the American Academy of Dermatology, American Psychiatric Association, American Academy of Family Physicians, American Academy of Allergy, Asthma and Immunology and Joint Council of Allergy, Asthma and Immunology. Although the contributing societies approved the project, they had no editorial control over publication or preparation of the manuscript.