Patient outcomes take a hit when physicians do clinical work on a part-time basis
Medicare patients treated by part-time clinical physicians have a lower 30-day mortality rate than those treated by full-time clinical physicians, according to new data published in JAMA Internal Medicine.
"Physicians are increasingly engaging in clinical practice on a part-time basis across the United States," wrote Hirotaka Kato, PhD, a specialist at the University of California, Los Angeles, and colleagues. "Nearly one in four physicians are estimated to work part time, which is up by nearly 11% since 1993. The growth of part-time clinical physicians is likely because of several reasons, including engagement in academic research, administrative and management responsibilities, caregiver responsibilities, and increasingly, as a remedy to limit physician burnout."
Of the 392,797 hospitalizations and 19,170 hospitalists included in the study, 61% were men. The median patient age was 41 years old. All patients were treated from 2011 to 2016, and all data came directly from CMS resources.
The study’s primary outcome was 30-day patient mortality. Its secondary outcome was 30-day patient readmission.
Looking at all hospitalists involved in this study, the average numbers of days worked clinically was approximately 65% lower among those in the lowest quartile of days worked than those in the the highest quartile (57.6 vs 163.3 days).
Overall, the authors found that the unadjusted 30-day mortality rate was 9.8%. After making certain adjustments, patients treated by physicians with a larger number of days worked clinically per year experienced a lower 30-day mortality rate than those who worked fewer days per year.
In addition, the unadjusted 30-day readmission rate was 15.3%. No direct associations were observed between readmission rate and physician workload.
“These findings suggest that part-time clinical care by physicians in the inpatient setting may be associated with greater patient mortality,” the authors wrote. “As the number of physicians who engage in part-time clinical work continues to increase, these findings should lead to careful consideration by health systems to reevaluate preventive measures to address potential unintended patient harm.”
Kato, et al., noted that previous research has found some potential benefits associated with being cared for by part-time physicians. For example, part-time physicians may be more likely to provide care that aligns with clinical guidelines.
Read the entire study here.