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It's About Time: Physicians' Perceptions of Time Constraints in Primary Care Medical Practice in Three National Healthcare Systems

Konrad, Thomas R. PhD*; Link, Carol L. PhD; Shackelton, Rebecca J. ScM; Marceau, Lisa D. MPH; von dem Knesebeck, Olaf PhD; Siegrist, Johannes PhD§; Arber, Sara PhD; Adams, Ann PhD; McKinlay, John B. PhD

doi: 10.1097/MLR.0b013e3181c12e6a
Original Article

Background: As physicians are pressured to deliver an increasing number of preventive services, follow guidelines, engage in evidence-based practice, and deliver patient-centered care in managerially driven organizations, they struggle with how much control they have over their time.

Methods: A secondary analysis was conducted with data from 3 parallel studies of clinical decision making in Germany, the United Kingdom, and the United States with 128 physicians per country. Physicians reported how much time they were allocated and how much time they needed for high-quality care for new patient appointments, routine consultations, and complete physicals. They also reported how much control they had over their time in the office and spending adequate time with patients.

Results: German, British, and American physicians were allocated (on average) 16/11/32 minutes for a new patient appointment, 6/10/18 minutes for a routine visit, and 12/20/36 minutes for a complete physical, but felt that they needed more time. Over half of German and American physicians felt that they always or usually had control over the hours they were required to be in their office or spending sufficient time with their patients while less than half of British physicians felt this way.

Conclusion: German physicians had the least time allocated and needed for most types of appointment. American physicians had the most time allocated and needed for each type of appointment. However, British physicians felt they had the least control over time in their office and spending sufficient time with patients.


From the *Cecil G. Sheps Center for Health Services Research, University of North Carolina at Chapel Hill, Chapel Hill, NC; †New England Research Institutes, Watertown, MA; ‡Department of Medical Sociology, University of Hamburg, Hamburg, Germany; §Institute for Medical Sociology, Heinrich Heine University of Düsseldorf, Düsseldorf, Germany; ¶Centre for Research on Aging and Gender, University of Surrey, Guildford, Surrey, United Kingdom; and ∥Warwick Medical School, University of Warwick, Coventry, United Kingdom.

Supported by the National Institutes of Health, National Institute on Aging, AG16747.

Reprints: John B. McKinlay, PhD, New England Research Institutes, 9 Galen Street, Watertown, MA 02472. E-mail:

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© 2010 Lippincott Williams & Wilkins, Inc.