Donna Izor, MS, FACMPE, gives a thorough analysis of the reasons why a newly employed physician's productivity might be less than it was in private practice [see “‘Why Did Your Productivity Decrease When We Hired You?’” July/August 2011]. However, I did find one possible reason that was not described in the article: The physician is now practicing a higher quality of care! Physicians in private practice are often driven to see more patients each day with shorter visits. In an employed situation, the employer may be committed to a higher quality of care, and spending more time with patients is an important part of that.

At our practice, half our patients are seniors, two-thirds are over age 55, and most have multiple medical problems and are on multiple medications. We also focus heavily on wellness and prevention. So, we ask our primary care physicians (an even mix of family physicians and internists) not to see more than 16 patients per day. Our physicians who communicate heavily with patients online see about 12 patients per day.

Primary care and family medicine need to reconsider traditional productivity measures and focus more on quality. Downstream revenue still makes primary care profitable for health systems, even with less focus on productivity.