Revisiting Panel Size

One of the more interesting articles I wrote a couple of years ago was about panel size. No not THAT kind of panel – and not THAT one either! In this case panel size means the number of patients that a doctor in practice carries as their active patient load. If a doctor has say 1,000 patients on their list then on average a certain percentage will be sick and need to see the doctor at any time. But since any one doctor only has a certain number of hours a day to see patients and since every patient takes a certain amount of time, there is a limit to how many patients any doctor can have on their ‘panel’. There are variables – how long on average a doctor takes per patient (which has been driven down to as low as 10 minutes in some cases) – and how often that patient population is likely to be sick (higher for infants and the elderly, etc.)
The twisty world of healthcare
It’s worth revisiting that post quickly. Go back and take a look. Back then the average doctor’s panel was 2,500 patients. And I calculated that that meant that on average each patient got 36 minutes with the doctor. No, not 36 minutes per visit – 36 minutes per year. Research had also shown that it would take a physician 18 hours per day to provide the recommended chronic and preventative services to an average patient panel – which is clearly not going to happen. So somebody gets short-changed along the line.

So has anything changed? Not really. One change is the rise of boutique doctors – doctors who have opted out of the insurance system altogether and who bill directly. Here’s one doctor’s take on why they were thinking about taking that route.

If anything it has gotten worse. There’s a reason why fewer and fewer people want to become primary care doctors. Just see the numbers and think about cause and effect. Between 2007 and 2001 the number of senior medical students choosing to go into general internal medicine declined from 9% to 2%. Basically the reason is that it is felt to be a lower compensated and higher stress field than other areas of medical practice.

Hopefully at some point the pendulum will swing back again, but it is probably going to take some serious policy reforms before that happens.

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