Does the Presence of Trainees Have an Effect on the Duration of Patient Appointments?
JAMA Ophthalmology, January 2018
In the current climate of electronic health records (EHR) and value-based reimbursement models, there is constant pressure to improve clinical efficiency. This can be especially challenging for academic medical centers, where trainees must be educated during the delivery of care. Goldstein et al. conducted research at an outpatient ophthalmology clinic and found that the presence of trainees correlated with lengthier appointments.
The single-center cohort study was performed at Oregon Health & Science University in Portland and included 49,448 patient appointments, 33 attending physicians, and 40 trainees. The trainees were residents or clinical fellows in ophthalmology. EHR audit logs were reviewed for time frames of clinical sessions, duration of patient appointments (determined from time stamps), and the presence/absence of a trainee during an appointment or a clinic session. Linear mixed models were devised to address variability among clinicians and patients.
During clinic sessions, patient appointments that involved a trainee were significantly longer than were those without a trainee (mean, 105.0 vs. 80.3 minutes).
Appointments with residents and fellows were 32% and 30% longer, respectively, than appointments without trainees. Presence of a trainee resulted in longer mean appointment times for 29 of the 33 attending physicians, shorter appointment times for 3 physicians, and no change for 1 physician. For all billing levels, trainee presence correlated with longer mean appointment times.
Although the authors acknowledged that study-design limitations can affect data interpretation, their findings highlight the challenge of maintaining efficiency in academic medical centers and raise questions about the suitability of current reimbursement models. The authors hope their work will inspire further research on medical education and clinical workflow, including ways to maximize learning, clinical efficiency, and care quality. They also encourage policy-making discussions of optimal methods to evaluate and reimburse physicians who practice in academic medical centers. (Also see related commentary by Jennifer L. Lindsey, MD, and Paul Sternberg Jr., MD, in the same issue.)
The original article can be found here.