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Across the United States, many states are struggling in preparation of implementing Obamacare as 2014 looms. Some are in process of setting up the Health Insurance Exchanges that will offer consumers and the Small Business Health Options Program (SHOPs) a mechanism to purchase coverage.  It is widely expected that the newly insured will create a demand for health access that cannot be currently met under existing models and limiting regulations. We can look to Massachusetts’ passage of mandated health coverage in 2006 and the backlog of access to primary care that it created to not repeat the same missteps.

Therefore, a number of states are currently examining existing nurse practitioner regulations that will enhance the availability of nurse practitioners to practice without arbitrary and non-evidence based barriers to increase the supply of available primary care providers.  For example, just this past week, both California and Nevada passed legislation that would ease the unnecessary restrictions of nurse practitioners and grant them full practice authority. Predictably, many who’d like to maintain the status quo, have come out in opposition of such legislative efforts by the states to address this issue. Under the veil of ensuring “patient safety,” groups like to readily point out that care is best when provided by health care teams that can only be led by a physician. This connection is made under the assumption that since physicians are in school for more years than anyone else and have more hours of “training” then they should be the ones best versed in care coordination and all other aspects of patient care.

Now a new study sheds some light on the quality of time that new physicians are spending with patients.  As noted by the NY Times’ Dr. Pauline Chen:

Researchers from Johns Hopkins University and the University of Maryland shadowed interns at two different internal medicine training programs over the course of almost 900 hours. They recorded the time the interns spent talking with and examining patients, meeting with families, attending educational conferences, discussing treatment plans with other doctors, sleeping, eating and even walking around the hospital.

As in earlier studies, the researchers found that current interns spend the majority of their time in activities only indirectly related to patient care, like reading patient charts, writing notes, entering orders, speaking with other team members and transporting patients.

But when they calculated the amount of time spent face to face with patients, the researchers found that interns were devoting about eight minutes each day to each patient, only about 12 percent of their time.” 

Yes, 8 minutes per patient. My point here is that for all of the rhetoric, the vast amount of time spent on actual care, a significant portion of that time is not dedicated to patient care. This was not the first study to uncover this phenomenon: a quick search found articles by Alromaihi et al (“…less time spent on direct patient care than other activities”), Boex et al (“… potentially as much as 35% [of residents time]…delivering patient care of marginal or no educational value,” Fletcher et al (“…Only 12 % of intern time was spent at the bedside”) and so on.

Organized medicine’s strategy is to tout how many more million hours physicians are trained compared with anyone else. Now that there is evidence showing the majority of those hours are not clinically significant, what will they think of next?

Stephen FerraraThis item was reposted from Stephen Ferrara is a practicing Nurse Practitioner with over 10 years of clinical experience. He blogs for and A Nurse Practitioner’s View.