Prevalence and predictors of physician reductions in clinical effort: A nationwide, longitudinal analysis
Date:
Rotenstein, L., Weinreb, G. G., Adler-Milstein, J., Landon, B. E. Download poster
Note: this research project evolved between the abstract submission and final poster presentation. The latter supersedes.
Research Objectives: While 40% of doctors report an intent to reduce their clinical hours, the true prevalence of physicians decreasing their work effort is unknown. There is particular interest in understanding these patterns for primary care physicians (PCPs), who are already in short supply. We sought to characterize the prevalence and extent of PCPs’ increases or decreases in clinical effort, trends in clinical effort changes over time, and the factors associated with PCPs changing their clinical effort.
Study Design: This was a longitudinal analysis of 2013-2021 from the Medicare Physician and Other Practitioners Dataset on the provision of services by physicians categorized as PCPs to traditional Medicare beneficiaries. After descriptively characterizing the sample, we tabulated annually PCPs’ yearly evaluation and management (E&M) services rendered to Medicare patients. We then calculated the prevalence over time of 10%, 20%, and 50% year-to-year increases or reductions in services rendered which were maintained for two additional years, as well as the prevalence of any 10%, 20%, or 50% yearto-year increase or decrease in PCPs’ services over the study period. Finally, we built multivariable logistic regression models to identify the PCP demographic and patient panel factors associated with any 20% decrease in services over the study period.
Population Studied: PCPs who provided at least 50 E&M services to Medicare patients during a minimum of three consecutive years from 2013-2021
Principal Findings: The study sample was comprised of 154,783 PCPs (85.1% MDs), including 44.2% internal medicine physicians. Most PCPs were male (62.0%) and 87.0% practiced in an urban setting. PCPs cared for a mean (SD) of 292.2 (308.7) Medicare beneficiaries with a mean (SD) risk score of 1.4 (0.6) and mean (SD) age of 71.8 (4.0) years. They rendered a mean (SD) of 634.6 (536.0)) outpatient E&M services. The mean annual frequency of 10%, 20%, and 50% year-to-year sustained reductions in services was 11.7%, 6.5%, and 1.6%, respectively. Almost half (46.4%) of physicians had a 10% sustained decrease in services at any point over the study period, while 31.0% had a 20% sustained reduction and 9.0% had a 50% sustained reduction. Only 9.9%, 7.4%, and 41% of PCPs had sustained 10%, 20%, or 50% increases in services.
Female physicians (OR: 0.77 (95% CI: 0.76, 0.79) were significantly less likely to have a 20% sustained reduction in services, while PCPs practicing in rural (vs urban) settings (OR: 1.37 (95% CI: 1.32, 1.41), and non-internal medicine physicians (OR 1.09 (95% CI: 1.07, 1.12) were more likely to reduce their services. Increasing panel risk score and increasing average patient age were associated with greater (p<0.0001) and lower (p<0.0001) likelihood of sustained service reduction, respectively.
Conclusions: Physician reductions in clinical effort are prevalent and persistent. Rural physicians, noninternal medicine physicians, and those serving more medically complex panels are more likely to reduce services rendered.
Implications for Policy or Practice: These findings suggest that we can expect to see an intensifying of the primary care supply crisis over time. They provide actionable insight into the factors that influence clinical effort reductions and can inform healthcare leaders seeking to understand primary care capacity for Medicare beneficiaries.