"For the physician who thinks she is overwhelmed, and for the patient who feels like he hasn't had enough time with his doctor, we're here to say, 'You're right.' There's not enough time," said Kimberly Yarnall, M.D., associate professor of Duke's department of community and family medicine.

The Duke study, published in the May/June 2005 issue of the Annals of Family Medicine, said the growing strain of chronic diseases on the health care system leaves little time for preventive care, acute care or other medical concerns.

The researchers said the health care system should support appropriate alternatives to costly one-on-one sessions between patients and a doctor. Such new approaches should emphasize a team approach among care-givers and could include group classes on disease management; videos that educate patients about diseases and treatments; online support groups for the psychological and emotional toll that some diseases bring; provider-monitored chat rooms for patients with questions; and print materials that patients could read in the comfort of their homes. The researchers cite insurance reimbursement as a major barrier for enacting such practices.

"The primary care system is at a crossroads. We are estimating a physician shortage in the next ten to fifteen years, but the demand for services continues to increase," said Lloyd Michener, M.D., chair of Duke's department of community and family medicine and senior author on the paper. "The status quo is not going to work much longer – it's not working now."

Michener said the bulk of chronic disease management falls to primary care physicians. Many patients have multiple chronic diseases and prefer not to visit separate specialists, whose insurance co-pays are typically more expensive than those for primary care physicians.

He and the other researchers studied the time constraints attached to 10 chronic diseases: high cholesterol, high blood pressure, depression, asthma, diabetes, arthritis, anxiety, chronic obstructive pulmonary disease (COPD), osteoporosis and coronary artery disease. The diseases were chosen because they occur widely and are among the main causes of death and illness in the U.S. population. Measures of national prevalence and published clinical guidelines also exist for the diseases.

To study the time required for chronic disease care, the researchers modeled a representative primary care practice. Using 2001 Census Bureau data, they assigned 2,500 "virtual patients" with appropriate ages (including children) and age-specific occurrence of diseases that match those of the general population. In the model, the family physician adhered completely to available guidelines for every patient.

The researchers allowed 10 minutes per chronic disease per patient, a conservative estimate considering other studies showing the average office visit per patient lasting 18 to 21 minutes. The number of visits per patient was dictated first by the average number of visits recommended by guidelines for the follow-up of stable disease, and then by the follow-up required for uncontrolled disease.