Spending time with patients: the impact of organizational structure on medical practice.

This article assesses whether the amount of time that physicians spend overall, in the office, and in the hospital per patient visit depends upon the organizational structure of the physician's practice (i.e., does the physician practice in the fee-for-service system or in an HMO, and if in an HMO, in what type of an HMO). Data pooled from two national studies (N = 2.521) reveal several interesting patterns, including: 1) on all measures, solo physicians spend more time per patient visit than physicians in group practice; 2) overall and in the office, internists spend more time per patient visit than general practitioners; 3) overall and in the hospital, obstetricians-gynecologists spend more time per patient visit than general practitioners; 4) overall and in the office, physicians in prepaid group practices spend less time per patient visit than physicians in fee-for-service group practices; 5) overall and in the office, physicians reimbursed on a straight salary basis spend more time per patient visit than nonsalaried physicians; and, 6) in the hospital, physicians in staff model HMOs spend more time per patient visit than physicians in fee-for-service group practice. The implications of these findings for future studies of the effects of organizational structure on medical practice are discussed.