Primary care physician productivity - The physician factor

David M. Smith, Douglas K. Martin, Carl D. Langefeld, Michael E. Miller, Jay A. Freedman

Research output: Contribution to journalArticle

30 Scopus citations


OBJECTIVES: To model physician productivity as a function of clinic (support system) characteristics and physician characteristics and to model the time a physician spends with the patient as a function of patient characteristics. DESIGN: Observational study. SETTING: A general medicine clinic of a university-affiliated Veterans Affairs medical center. PATIENTS: A cohort of 2,520 patients having 2,721 consecutive outpatient visits to 56 physicians. MAIN OUTCOME MEASURES: Physician productivity defined as patients seen/physician/hour and time (minutes) spent with the patient. RESULTS: Physicians saw a mean (±SD) of 1.62±0.68 patients/hour. Clinic characteristics explained 8.2% of the variability of session-specific physician productivity. Controlling for clinic characteristics, a factor representing the physician explained an additional 55.4%. A model for overall physician productivity, using physician characteristics, explained 84.9% of the variance, and time spent with the patient was an important predictor. Modeling physician time with patients, patient characteristics accounted for only 7% of the variability. Controlling for patient characteristics, the individual physician again provided the greatest explanatory power, an additional 22.8% of the variability. CONCLUSIONS: Physicians' practice patterns, rather than clinic or patient characteristics, may account for most of the variation in physician productivity. Given the magnitude of the influence of individual practice patterns, interventions to increase productivity need to consider methods to affect physician behavior.

Original languageEnglish (US)
Pages (from-to)495-503
Number of pages9
JournalJournal of general internal medicine
Issue number9
StatePublished - Sep 1 1995


  • behavior
  • medical
  • practice management
  • practice patterns
  • primary care physicians
  • productivity

ASJC Scopus subject areas

  • Internal Medicine

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