Annual face time between patients and physicians rose since 1979 due to longer visits

Americans' annual face time with office-based physicians rose for three decades after 1979, but racial disparities remain, particularly for those seen by specialists, a study found.

To investigate trends and racial/ethnic disparities in the amount of annual face time with physicians, researchers looked at the National Ambulatory Medical Care Survey in 1979 to 1981, 1985, 1989 to 2016, and 2018. Researchers reviewed 1,108,835 patient visits for race/ethnicity (White, Black, and Hispanic), age (<18, 18 to 64, and ≥65 years), and survey year. The primary outcome was patients' annual visit face time with a physician. Secondary outcomes include annual visit rates and mean visit duration. Results were published June 6 by the Journal of General Internal Medicine.

From 1979 to 2018, annual outpatient physician face time per capita rose from 40.0 to 60.4 minutes, an increase driven by a rise in mean visit length from 15.4 to 22.2 minutes. While visits per capita rose somewhat in the first three decades after 1979, they fell in the most recent decade, resulting in little net change between 1979 and 2018 (~2.6 to 2.7 visits per capita). However, since 2005, mean annual face time with a primary care physician has fallen, a decline offset by rising time with specialists. Face time per physician changed little despite growth in the physician workforce.

Changes in mean annual face time by specialty mirrored changes in the number of physicians: From 2005 to 2018, despite population growth, the weighted number of primary care physicians in the sample fell from 151,836 to 147,494, whereas the numbers of surgeons and medical specialists rose from 68,398 to 69,031 and 86,611 to 103,452, respectively. Annual face time per primary care physician changed little (65.4 to 66.0 thousand minutes per physician), and face time rose modestly with surgeons (52.2 to 58.5 thousand minutes) and medical specialists (52.4 to 54.1 thousand minutes).

A racial/ethnic gap in physician visit time, present at the beginning of the study period, widened over time. Between 1979 and 2018, mean annual physician face time per capita rose from 42.7 to 68.0 minutes among White patients, from 29.6 to 45.1 minutes among Black patients, and from 31.1 to 53.3 minutes among Hispanic patients. Hence, the White-Black gap rose from 13.1 to 22.9 minutes and the White-Hispanic gap from 11.6 to 14.7 minutes. Racial/ethnic disparities persisted throughout the study period among patients under age 65 years, but narrowed among those ages 65 years and older. This disparity was driven by differences in visit rates, not mean visit length, and in the provision of specialist, not primary, care.

The study authors wrote that declining primary care visit rates and face time may help explain worsening population-level control of two conditions—hypertension and diabetes—that are mostly managed by primary care physicians. “Our finding that absolute disparities in physician face time have widened since the late-1970s is concerning,” authors wrote. “Our (and others') findings suggest that income and racial disparities in care improved in the wake of the 1965 passage [of] Medicare and Medicaid, but may have subsequently widened—similar to the face time-focused findings of this study.”