Association Between Part-Time Clinical Work and Patient Outcomes: A Pharmacy Perspective

The pharmacy profession has been focusing on greater clinical practice for decades. Clinical practice has flourished in institutional care but has lagged in community practice. Thereby, calls for transformation of community practice and accompanying payment methods are increasingly being heard across the profession.¹ As this movement gathers momentum, it is important to recognize, a priori, how pharmacy will transition to this type of practice in community settings. Pharmacists will need to study human resource issues such as how to handle part-time workers in this new transformation.

To this point, a recent cross-sectional analysis examined the association between the number of days clinically worked per year by physicians and 30-day patient mortality.² A secondary outcome of 30-day patient readmission was also studied. This design involved 392,797 hospitalizations from a random sample of Medicare fee-for-service beneficiaries aged 65 years or older, who were admitted for an emergency medical condition and treated by a hospitalist from 2011-2016.  Data were adjusted for patient and physician characteristics and hospital fixed effects (comparing physicians within the same hospital).

Physicians treating patients had a 30-day mortality reference rate of 10.5% for 57.6±12.9 days worked per year, compared to:

• 10.0% (adjusted risk difference [aRD], -0.5%; 95% CI: -0.8% to -0.2%; P=.002) for 98.5±10.4 days worked per year;
• 9.5% (aRD, -0.9%; 95% CI: -1.2% to -0.6%; P<.001) for 130.8±8.6 days worked per year; and
• 9.6% (aRD, -0.9%; 95% CI: -1.2% to -0.6%; P<.001) for 163.3±12.0 days worked per year (highest part-time work).

Readmission rates were not associated with number of days clinically worked.

This study supports that clinical knowledge, when not utilized, can frequently diminish. When physicians or any clinician must balance multiple work-life obligations, clinical outcomes may be affected. In addition, practice continues to evolve, with substantial changes occurring in the literature and rapidly incorporated into clinical guidelines, necessitating the maintenance of knowledge and clinical practice.

As the field moves toward a greater clinical focus, pharmacists need to study patient outcomes constantly and consistently in a longitudinal manner, not only to understand the impact of part-time vs full-time work, but also to justify practice or payment transformation initially and over time.

References:

1. Rapid Alliance Research Consortium. Rapid Alliance 2021 Report: Implementation Science-Informed Strategies for Optimizing Access to and Outcomes from Medications, Vaccines, and Related Therapies for all US Residents through Pharmacists and Pharmacies Working in Collaboration with Connected Stakeholders During and After the COVID-19 Pandemic. Rapid Alliance; 2021. https://www.rapidalliance.org/learning-center#h.8sksej6xibg7
2. Kato H, Anupam JB, Figueroa JF, Tsugawa Y. Association between physician part-time clinical work and patient outcomes. JAMA Intern Med. 2021 Nov 1;181(11):1461-1469. doi:10.1001/jamainternmed.2021.5247