Measuring the dimensions of physician work.

Abstract

Medicare has adopted a physician fee schedule that places emphasis on measuring physicians' work. We assessed the construct validity of self-reported work scores for 11 selected medical services performed by 44 internists in two large group practices. These physicians' work scores correlated highly with their ratings of time, physical and mental effort, and stress required to produce the services. Eighty-five percent of the variance in total work scores could be explained by the dimensions of work. Time was the most important input, but mental effort also was important for internists. We also found that physicians may reduce the total work required to produce two services for a patient if they provided those services in one visit, rather than in separate visits. Savings occurred for service pairs in which the physician could reduce his or her own time. Our findings imply that the Medicare fee schedule pays internists mainly for the time and mental effort required to produce medical services. They also underscore the importance to physicians of saving time by providing two services during the same patient visit.