With Whom Does the Surgeon Spend More Time? A Study of the Orthopaedic Foot and Ankle Clinic

CATEGORY: Health Sciences Research INTRODUCTION/PURPOSE: In the era of decreasing reimbursement and increasing financial pressure on the orthopaedic foot and ankle surgeon, improving clinic efficiency has value. The purpose of this study was to identify which patients and which types of clinical visits consume the greatest amounts of an attending orthopaedic foot and ankle surgeon’s time. METHODS: A prospective, observational study was conducted in an outpatient orthopaedic foot and ankle clinic at a tertiary medical center. 210 adult patients were enrolled from the clinics of two fellowship-trained, board certified orthopaedic surgeons. Time spent in the exam room with the attending surgeon was the primary outcome. Independent variables included patient and appointment characteristics (i.e. age, sex, new/follow-up appointment, etc.). Linear regression was used to test for association between the independent variables and the primary outcome. RESULTS: Mean time spent by the attending surgeon in the exam room (± standard deviation) was 7.4±4.4 minutes (range, 1-20). Predictors of greater time spent in the exam room included patient age≥50 years (+2.0 minutes, 95% confidence interval [CI]=+0.8 to +3.1, p=0.001), female sex (+1.7 minutes, 95% CI=+0.5 to +2.9, p=0.005), outside medical records reviewed (+2.4 minutes, 95% CI=+0.6 to +4.2, p= 0.010), and new (versus follow-up) patient appointment (+1.7 minutes, 95% CI=+0.5 to +2.9; Table 1). In contrast, time spent in the exam room was not associated with the patient arriving late, completion of patient paperwork before the appointment, whether the patient obtained x-rays at the visit, or the type of provider that saw the patient prior to the attending (resident/physician assistant; p>0.05 for each). CONCLUSION: Patients who are age=≥50, identify as female, bring outside medical records for review, and are presenting to the surgeon for the first time consume the greatest amounts of a surgeon’s time in the examination room. Surgeons can anticipate spending more time in the room with these types of patients and should schedule their clinics accordingly.