Effects of increasing appointment lengths on patient experience, clinician burnout, and care quality in primary care

Short primary care appointment length has been linked to worse patient and clinician outcomes/experience. We sought to assess the impact of changing primary care appointments from 15/30/45 minutes (for acute visit for low-risk conditions, all established patient visits, all new patient visits, respectively) to 40 min for all types visits on care quality, patient experience, and clinician burnout. Retrospective quasi-experimental analysis of electronic health records and surveys of patient experience and clinician burnout for the 3 months preceding (August – October 2021) and following (February – April 2022) institutional change in primary care internal medicine appointment lengths (November 2021). We included all patients seen in four primary care internal medicine practices by any of 61 clinicians (physicians, nurse practitioners, physician assistants) working in those practices for ≥ 1 year. We quantified the relative changes in patient experience, clinician burnout, care quality (preventive screening, chronic disease management), and emergency department/hospitalization rates following transition to 40-minute appointments. Improvement was seen in patient experience scores for wait time at clinic (percent change = 3.8%, p = 0.03), with no change in other domains of patient experience. Cervical cancer screening increased 21.1% ( p < 0.001), mammogram completion increased 0.9% ( p = 0.004), while hypertension control decreased 1.8% ( p < 0.001); remaining quality metrics did not change. Clinician burnout improved, though did not reach statistical significance, with the high emotional exhaustion score decreasing from 43.9% to 31.3% of clinicians and high depersonalization score decreasing from 21.9% to 12.5% of clinicians. Within 3 months of changing all primary care appointments to 40 min, we observed improvements in patient satisfaction with wait times and improvements in some though not all process and outcome quality measures. Clinician burnout measures trended in an improved direction but did not reach statistical significance. These early results point to potential solutions to improving care quality, patient satisfaction, and clinician experience in primary care, but will need to be examined further after longer implementation and in other settings and populations.