The average primary care doctor needs to work six more hours a day than they already do, in order to make sure their patients get all the preventive and early-detection care they want and deserve, a new study finds.

Primary care doctors' sleep, personal hygiene and family time need to take a back seat, so they can add 29 minutes to each patient appointment, the study shows. Fortunately, the new study was written as a parody and is published in the satirical Christmas edition of the journal BMJ by a team from the University of Michigan.

But the study concludes that if they did, it would give primary care doctors just enough time to work with each patient to discuss and decide which preventive health options they should choose based on the risks, benefits, and costs.

The study focuses just on the evidence-backed national recommendations from the Preventive Services Task Force—from colonoscopy and proactive lung cancer screening scans to vaccination and daily aspirin. The researchers built and ran a computer simulation based on real-world data to reach their conclusions.

Unfortunately, all this shared decision making about prevention would crowd out any time to discuss the patient's actual medical complaints. And, the researchers conclude, it would lead 17 out of every 100 doctors to take early retirement each year.

Primary care doctors

But the authors of the new paper—two of whom are general practitioners themselves—say their findings make a clear point. The idea that primary care doctors can engage in detailed shared decision-making with every patient, for every proven form of prevention, is completely impossible.

"This may be satire, but it actually allows us to make these points more strongly than we otherwise could," says Tanner Caverly, M.D., MPH is the study's lead author and a general practitioner at U-M's academic medical center, Michigan Medicine.

"One of the primary care's main roles is that we are the ones who absorb everything that our patients need, and every demand for improved preventive care. Prevention is just one of the things we do."

Caverly worked with fellow U-M primary care physician Rodney Hayward, M.D., and U-M neurologist James Burke, M.D., to create a computer model of the way 1,000 different doctors might spend their clinic time if they each had to take care of 2,000 primary care patients.

The patients' medical conditions and levels of illness and disability were based on a sample of data from a real collection of patients tracked in a national study. They also varied many aspects such as the patient panel size and annual work-hours before drawing conclusions.

Caverly and his colleagues modeled the time needed to address recommendations from the USPSTF, a group of health professionals that examines the entire body of research around specific preventive services. The USPSTF makes recommendations of varying strengths to guide clinical care nationwide. Their recommendations, which are considered the most rigorous and scientifically based, also help guide insurance coverage of preventive services.

"My colleagues and I care a lot about shared decision making, and how to get preference-sensitive care right, but these data show it's a matter of walking a fine line. What we call full-share decision making is not feasible for these types of decisions, so we have to come up with a model of shared decision-making that is more feasible."

Caverly has studied lung cancer screening and built a tool with colleagues that can help physicians understand which of their patients really have a decision to make about whether to get a CT scan to check for signs of lung cancer.

The USPSTF made a recommendation about such screening, but actually implementing it in clinical practice can be a challenge because many patients would not get enough benefit from such scans to warrant the worry and potentially invasive procedures that they can lead to. But some patients truly could benefit from the scans and need a strong recommendation from their physician.