Doctors Are Losing More Than an Hour a Day to Phone Call Overhead

While I was working on our recent profile of Wellness for Life and their innovative approach to patient calls, I began to wonder just how much time the average practice loses to the phone. In my calculation, it might actually be more than an hour a day per clinician. That number also excludes non-patient calls and considers only the overhead of each phone call, not its productive talk time, so the real losses may be even higher.

If you just want the bottom-line stat, then that’s it: every provider in a medical practice will generate more than an hour of wasted phone-related time every single day. If you want to see the methodology behind that number, however, read on for an avalanche of evidence (and a slightly smaller avalanche of gut-feeling assumptions that I will do my best to flag).

Medical Practices Get (And Make) a Ton of Phone Calls

We’re going to consider primary care outpatient settings for this analysis because such offices handle about half of all outpatient encounters, and nearly 40% of physicians identify with a primary care specialty, so this seems like a reasonable scope to set to maximize applicability.1,2

First, let’s see how many calls primary care offices are making and receiving every day. Good data exist from multiple different sources on incoming patient call volume, so let’s start there:

Incoming Patient Call Volume for Seven Practices

Patients Calls/Day per 1,000 Patients Source
8,440 11 NEJM3
32,000 19 Medical Economics4
10,889 19 JABFM5
18,243 17 JABFM5
9,685 21 JABFM5
11,868 33 JABFM5
15,217 26 JGIM6

These numbers are fairly similar, which is reassuring for accuracy, and they average out to 21 incoming patient calls per day for every thousand panel patients.

There didn’t seem to be such solid data for outgoing calls, but one internally published academic study examined nine primary care sites and found a 10:7 ratio of inbound to outbound calls, so we’ll go with that.7

Next, we need to know how large the average primary care patient panel is. An oft-quoted number is 2,500 patients, but this has been shown to be erroneously high. Instead, the best data suggest that panels most commonly contain 1,200 to 1,900 patients per provider.8 We’ll use a medium panel size of 1,500 patients per provider for our calculations.

If we then combine all of the numbers that we have so far, we end up with an estimate for the total call volume per primary care provider per day:

A typical provider has 53 patient calls per day!

This number doesn’t attempt to count non-patient calls, such as those from pharmacies, insurance companies, drug reps, or other medical practices, so it is by nature a conservative estimate. Realistically, some providers will generate even more than 53 calls per day. But it seems like a reasonable baseline.

Phone Calls Have a Lot of Overhead

Now that we have an estimate of the number of patient calls per provider per day, the question becomes how much overhead time each of those phone interactions eats up. For this analysis, we’ll count an activity as “overhead” if it relates to a phone call but isn’t actual medical conversation between a patient and provider.

We’ll also assume that the medical practice in question has front-office staff that make and receive 90% of all calls and that 26% of incoming calls can be handled entirely by these staff members, with no need for clinician input. The first number is an assumption, but the second is based on call data from an actual primary care practice.3

With that setup in mind, let’s pick some numbers:

  • Call overhead for all calls
    Let’s say that every call, inbound or outbound, has about 30 seconds of overhead time. This includes things like pleasantries, listening through rings and voicemail greetings, and time spent waiting for the other party to find information or formulate responses. This number is an estimate, but I tried to be conservative with it. We’ll also assume that every call must be logged in the practice’s EMR, which takes 15 seconds.
  • Specific inbound call overhead
    Inbound calls are either answered or go to voicemail. Let’s say that the practice answers 80% of its calls live and that 20% go to voicemail. For the ones that go to voicemail, a staff member has to listen to them and take notes, which we’ll assume requires 45 seconds (or just 30 if it’s an issue that they can handle by themselves and doesn’t need notes). Then the staff member has to hand off clinician-level issues to a provider (45 seconds for both people) and follow up with the provider later to close the loop (30 seconds for both people).
  • Specific outbound call overhead
    Let’s be generous and assume that no outbound call requires handoffs or any other overhead time beyond what we’ve already discussed.

With those numbers decided, we can calculate the average overhead time per phone call: 97 seconds per inbound call and 45 seconds per outbound call.

Then a little simple math (31 inbound calls with 97 seconds of overhead each, plus 22 outbound calls with 45 seconds of overhead each) gives us our final number for overhead:

Each provider generates 66 minutes of phone call overhead per day!

A lot of this time is front-office staff time, but that is still a significant burden for any practice. And again, this does not count “productive” talk time; this is purely lost time that could conceivably be recovered with a more efficient communication system.

You Can Recover Most of That Wasted Phone Time

It’s only useful to know that you’re losing time to phone calls if you can do something about it, and fortunately, you can. Nearly every step we considered in our analysis above can be made more efficient, or omitted entirely, with a modern communication system that treats your phone setup as a seamless part of your overall practice and medical record, while also leveraging new technologies like voicemail transcription, secure messaging, texting, and email.

I’m obviously biased, since efficient medical communication is our bread and butter at Spruce, but I think the math checks out. Let’s pick a few more numbers to see just how much time you can save with a better communication setup:

  • Divert calls to more efficient communication channels
    As we saw above, phone calls require a lot of overhead time. Technologies like secure messaging and email, on the other hand, simply don’t. Your time isn’t monopolized while you wait for responses, you can read faster than patients can speak, communication that begins in written form is easier to pass between teammates (no note-taking!), and pleasantries are much shorter. We wrote an entire ebook on how our society is moving to communication channels that are more efficient than the phone, so we have the data to back up your gut feeling on this. With this in mind, let’s say that a savvy practice can divert half of its calls to more efficient channels, and that each of those interactions then only requires 20 seconds of overhead time while also making information transfer 30 seconds faster.
  • Make the unavoidable phone calls more efficient
    Some phone calls are unavoidable, but there are still ways to make them more efficient. Spruce, for example, automatically logs call metadata in the medical record (i.e., who is calling whom, when it happened, and how long the call was), which eliminates the need to manually curate call records. We also keep secure copies of voicemails and their automatic transcriptions right in a patient’s record, saving your staff the time of having to find and listen to every voicemail. If you combine these improved telephony features with our simple team messaging, native mobile apps, and configurable notifications, you can save about 60 seconds per call in total system overhead.

Running these numbers back through our calculations above, our theoretical practice from before would recover 57 minutes per provider per day, or 86% of its wasted time, by modernizing its approach to phone calls. That’s pretty powerful.

Spruce can recover 86% of the time that a practice loses to phone call overhead, or nearly an hour per provider every day!


Ready to stop losing hours every day to the phone? Spruce can help you take your communications to the next level, delighting your patients and taking back control of your time and your practice.

Get started on Spruce, and make your communications the best that they can be.


References:

  1. Centers for Disease Control and Prevention (CDC). National Ambulatory Medical Care Survey (NAMCS): 2015 State and National Summary Tables. (CDC, 2010/2017).
  2. Ray, W. et al. 2016 Survey of America’s Physicians: Practice Patterns and Perspectives. (The Physicians Foundation, 2016).
  3. Baron, R. J. What’s keeping us so busy in primary care? A snapshot from one practice. N. Engl. J. Med. 362, 1632–1636 (2010).
  4. Lippman, H. Re-engineering your practice: Do patients love you, but hate your phones? Medical Economics 18, (2000).
  5. Dexter, E. N. et al. Patient-Provider Communication: Does Electronic Messaging Reduce Incoming Telephone Calls? J. Am. Board Fam. Med. 29, 613–619 (2016).
  6. Liederman, E. M., Lee, J. C., Baquero, V. H. & Seites, P. G. Patient-physician web messaging. The impact on message volume and satisfaction. J. Gen. Intern. Med. 20, 52–57 (2005).
  7. Nason, J. C. Telephone Usage at Mercy Hospital’s Primary Care Practices. Muskie School Capstones, University of Southern Maine, USM Digital Commons (2015).
  8. Raffoul, M., Moore, M., Kamerow, D. & Bazemore, A. A Primary Care Panel Size of 2500 Is neither Accurate nor Reasonable. J. Am. Board Fam. Med. 29, 496–499 (2016).

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