Are patients' office visits with doctors getting shorter?

By Rhonda Rowland
CNN Medical Correspondent

NEW BRUNSWICK, New Jersey (CNN) -- If you think you're getting short shrift at the doctor's office, it's a misperception, according to a study in the New England Journal of Medicine. The length of a typical visit with a doctor has actually increased during the past decade, whether your health insurance coverage is fee-for-service or managed care.

"I was initially quite surprised by the findings," said David Mechanic, from the Institute for Health, Health Care Policy and Aging Research at Rutgers University. "I had bought into the doctors' contention that they were spending less time with patients, one of the many misconceptions about managed care."

But according to the study, doctors spend only slightly more time -- about 36 seconds on average -- with fee-for-service patients than managed care patients.

"The time spent with patients regardless of insurance type is converging very clearly," said Mechanic, "I suspect doctors develop a routine and don't change it according to the type of patient they're seeing."

Researchers examined data from two large, national databases -- the National Ambulatory Medical Care Survey (NAMCS) of the National Center for Health Statistics and the American Medical Association's Socioeconomic Monitoring System.

In 1989, according to NAMCS data, doctors spent an average of 16.4 minutes with fee-for-service patients -- that increased to 18.5 minutes in 1998. Ten years ago doctors spent an average of 15.4 minutes with pre-paid, managed-care patients -- by 1998 it increased to 17.9 minutes. The trend held whether patients were seeing primary care physicians or specialists, as well as for common or complex medical problems.

"In both settings, the length of visits has increased significantly since 1989, which is the opposite of what most would have expected," wrote Dr. Edward Campion in a journal editorial.

Researchers discounted possible explanations for the rise in office visit time, such as an increase in female doctors who tend to spend more time with patients and a greater complexity in case mix.

The findings still raise the question: why is there the perception that doctors are squeezed for time during patient office visits?

"The blame has mainly been laid on managed care, and managed care is probably responsible for some of the pressures that make office visits feel shorter," said Campion in an interview with CNN. "But the problem lies not just in managed care, but in all parts of the health care delivery system."

Physicians are faced with multiple systems and rules, the need to seek authorization to perform tests and exams and requests for documentation.

"Perhaps this will help us to realize that the problem is not the number of minutes of these visits," said Campion, "but relates to deeper problems in the health care delivery system, and the inefficiencies in the system we now have to live with."

He admits there isn't a crisis in health care and there's little pressure to change the system in the immediate future.