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A Conceptual Model of Physician Work Intensity: Guidance for Evaluating Policies and Practices to Improve Health Care Delivery

Horner, Ronnie D. PhD*; Matthews, Gerald PhD; Yi, Michael S. MD, MSc

doi: 10.1097/MLR.0b013e31825516f7
Original Articles

Background: Physician work intensity, although a major factor in determining the payment for medical services, may potentially affect patient health outcomes including quality of care and patient safety, and has implications for the redesign of medical practice to improve health care delivery. However, to date, there has been minimal research regarding the relationship between physician work intensity and either patient outcomes or the organization and management of medical practices. A theoretical model on physician work intensity will provide useful guidance to such inquiries.

Objective: To describe an initial conceptual model to facilitate further investigations of physician work intensity.

Research Design: A conceptual model of physician work intensity is described using as its theoretical base human performance science relating to work intensity. For each of the theoretical components, we present relevant empirical evidence derived from a review of the current literature.

Results: The proposed model specifies that the level of work intensity experienced by a physician is a consequence of the physician performing the set of tasks (ie, demands) relating to a medical service. It is conceptualized that each medical service has an inherent level of intensity that is experienced by a physician as a function of factors relating to the physician, patient, and medical practice environment.

Conclusions: The proposed conceptual model provides guidance to researchers as to the factors to consider in studies of how physician work intensity impacts patient health outcomes and how work intensity may be affected by proposed policies and approaches to health care delivery.

Departments of *Public Health Sciences


Internal Medicine, University of Cincinnati, Cincinnati, OH

Supported, in part, through funding from the American Academy Neurology, American Academy of Dermatology, American Psychiatric Association, American Academy of Family Physicians, American Academy of Allergy Asthma & Immunology, and Joint Council of Allergy, Asthma & Immunology. The views expressed are those of the authors and do not necessarily reflect those held by any of the supporting organizations.

The authors declare no conflict of interest.

Reprints: Ronnie D. Horner, PhD, Department of Internal Medicine, Stetson Building, Suite 4200, 260 Stetson Place, Cincinnati, OH 45219. E-mail:

© 2012 Lippincott Williams & Wilkins, Inc.