Continuity of Care Increases Physician Productivity in Primary Care

Abstract

Continuity of care, defined as an ongoing therapeutic relationship between a patient and a physician, is a defining characteristic of primary care. However, arranging a consultation with one’s regular doctor is increasingly difficult as practices face physician shortages. We study the effect of declining care continuity on the productivity of physicians by analyzing data of over 10 million consultations in 381 English primary care practices over a period of 11 years. Specifically, we examine whether a consultation with the patient’s regular doctor is more productive than with another doctor in the practice. Using statistical models that account for confounding and selection bias and restricting the sample to consultations with patients who had at least three consultations over the past two years, we find that the time to a patient’s next visit is on average 18.1% (95% confidence interval: 16.9%, 19.2%) longer when the patient sees the doctor they have seen most frequently over the past two years, while there is no operationally meaningful difference in consultation duration. The data show that the productivity benefit of care continuity is larger for older patients, patients with multiple chronic conditions, and patients with mental health conditions. We estimate that the total consultation demand in our sample could have fallen by up to 5.2% had all practices offered continuity of care at the level of the top decile of practices while prioritizing patients expected to yield the largest productivity benefits. We discuss operational and strategic implications of these findings for primary care practices and for third-party payers. This paper was accepted by David Simchi-Levi, healthcare management. Supplemental Material: The online appendix and data files are available at https://doi.org/10.1287/mnsc.2021.02015 .