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Is a Part-Time Physician Competent?

October 21, 2021

Written by Clay Smith

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Reduction in time spent working clinically was associated with greater mortality among inpatient hospitalists.

Why does this matter?
Clinicians often have other responsibilities that reduce their clinical time, such as research, administration, education, or family commitments. Does a reduction in clinical time mean a reduction in the quality of care?

Yeah, I do a little brain surgery on the side…

Design: This was a cross-sectional analysis of Medicare patients over age 65 cared for by various hospitalists, with varying numbers of days worked per year.

Results: 30-day mortality was higher when patients were cared for by hospitalists who worked fewer days per year: bottom quartile 10.5%; second quartile 10%; third 9.5%; fourth 9.6%. There was no difference in 30-day readmission rate.

Implications: There was an association with greater clinical workload and improved mortality, which indicated possible skill decay among physicians who worked less. Physicians with a lower clinical load may need greater support. The magic number was 130 days per year. Above that, there was no significant improvement in mortality.

Limitations: This was a natural experiment and not a randomized study. Unrecognized factors could have confounded results. However, they performed 8 different sensitivity analyses, so the conclusions are probably correct. Finally, having outside interests or, “extracurricular activities can be a way to develop new skills, meet new people and communities, or decompress.” according to the Harvard Business Review. It is possible that outside but related interests could act synergistically and enhance job performance in some situations, but that was not the focus of this study.

Association Between Physician Part-time Clinical Work and Patient Outcomes. JAMA Intern Med. 2021 Sep 13. doi: 10.1001/jamainternmed.2021.5247. Online ahead of print.

What are your thoughts?