Determinants of PCP Workload: How Patient Complexity and Medicaid Status Drive Time Expenditure

Article Impact Level: HIGH
Data Quality: STRONG
Summary of Annals of Internal Medicine, https://doi.org/10.7326/ANNALS-25-01412 
Dr. Lisa S. Rotenstein et al.

Points

The median yearly work effort for a full-time (1.0-cFTE) Primary Care Physician (PCP) was estimated at 2,844.3 hours, based on data from 406 attending PCPs in 2021.
This corresponds to a median of 61.8 weekly hours, or 1.7 hours of dedicated time per patient annually across the median 46-week work year.
Part-time PCPs were found to spend more time per patient on average than full-time PCPs, suggesting differences in efficiency or workload distribution.
The time PCPs spent per patient was positively correlated with patient medical advice request volume, reflecting the uncompensated workload associated with digital communication.
Panel characteristics such as greater average patient age, higher medical complexity, and a larger proportion of patients with Medicaid coverage were linked to higher time expenditure.

Summary

This cross-sectional, observational study used Electronic Health Record (EHR) and administrative data from 33 clinics within the Mass General Brigham health system to estimate the annual work effort of Primary Care Physicians (PCPs). The analysis included 406 attending PCPs who provided care for at least nine months during 2021. Work effort was estimated both per patient and per full-time physician, with adjustments made using literature-based factors to account for tasks not fully captured by the EHR.

The median yearly work effort for a full-time (1.0-cFTE) PCP was 2,844.3 hours (IQR, 2,324.9 to 3,478.9 hours), assuming a 46-week work year. This equates to a median of 61.8 weekly hours (IQR, 50.5 to 75.6 hours) and 1.7 hours per patient annually (IQR, 1.4 to 2.2 hours). Part-time PCPs consistently spent more time per patient compared to full-time physicians.

The study identified several factors contributing to greater PCP time per patient, including higher volumes of patient medical advice requests and larger shares of Medicaid-covered patients. Additional panel characteristics such as older average patient age and greater medical complexity were also associated with higher physician workload, highlighting the disproportionate time demands faced by PCPs serving medically and socioeconomically complex populations.

Link to the article: https://www.acpjournals.org/doi/10.7326/ANNALS-25-01412

References

Rotenstein, L. S., Frits, M., Iannaccone, C., L’Heureux, M., Fangman, J., Rancier, M., Gitomer, R., Bates, D. W., & Landon, B. (2025). Primary care physician time spent in patient care: An observational study using electronic health record logs. Annals of Internal Medicine, ANNALS-25-01412. https://doi.org/10.7326/ANNALS-25-01412