Physician workload in primary care: what is the optimal size of practices? A cross-sectional study.

Objective: To determine the impact of practice size and scope of services on average physician workload in primary care practices in The Netherlands, and to examine the associations between average physician workload, average assistant volume and organisational practice characteristics.

Methods: This was a cross-sectional study in 1188 general practices in The Netherlands. Measures included physician workload per week per 1000 patients, assistant volume per 1000 patients, practice size defined by number of registered patients (10 classes), scope of disease management services (seven classes), and nine organisational characteristics of the practice.

Results: Physician workload per 1000 patients differed across levels of practice size, but was not related with the range of disease management services provided. In the smallest practices physicians worked on average 26.2h per 1000 patients and in the largest practices 18.1h. A higher average assistant volume was overall not associated with a lower average physician workload. Large practices had lower assistant volume per 1000 patients, but provided a wider range of disease management services compared to small practices. Delegation of medical tasks was associated with reduced physician workload per 1000 patients, mainly in smaller practices, and with higher assistant volume per 1000 patients, particularly in larger practices.

Conclusions: In The Netherlands the optimum regarding average physician workload was found in the largest practices, while no obvious association with scope of disease management services appeared. It may be that in large practices medical tasks were delegated to practice assistants to provide a wider scope of disease management services and in small practice to reduce average physician workload.