What does your doctor do all day? Pretty much the same as you: talk on the phone, send e-mail, read and write reports.
Yes, primary care doctors see plenty of patients, too, but an awful lot of their time goes to what amounts to bookkeeping and medical traffic control.
A Philadelphia doctor reports in the current issue of the New England Journal of Medicine just how crammed the days are at Greenhouse Internists, the five-doctor practice he's part of.
It's an illuminating snapshot of the current challenges in primary care. For starters, try juggling nearly 24 calls, a dozen prescription refills and about 45 different patient reports for each doctor each day.
The real problem may not be that primary care doctors do so much, but that they get paid by the patient visit. In the Greenhouse group, each doctor sees 18 patients a day.
We called Dr. Richard Baron, one of the Greenhouse doctors and author of the article, to find out more. Right off the bat, he said, everybody in the practice was surprised by the numbers. "None of us has really understood what the work of primary care is," he said.
Then there's the resentment factor once the reality of the job sinks in. Sure, getting an email from the doctor might save you from taking time off work for an appointment in person. But for the doctor, the email took time and spoiled a chance for an in-person visit that would have led to a bill.
"Technology has changed everybody's work," says Baron, who has practiced in Philadelphia for 26 years. "It's not unique to primary care physicians by any means. The challenge is that in other areas of medicine, technology changes work in ways the payment system supports." For example, reading an MRI pays more than reading an old-fashioned X-ray, he says.
Doctors in primary care are discouraged by their workloads and lower pay than specialists get.
So what's the solution to the problems?
One idea is to pay primary care doctors for providing patients with a "medical home," where doctors are compensated to coordinate care and help patients stay well.
Doctors also have to rejigger their practices and use technology to keep up with what patients need.
Baron's advice to fellow primary care doctors:
Take an honest look at this work and see what it does for patients. Don't resent it because you don't get paid for it. Organize yourselves to be able to respond to it.