Docs with their eyes on the clock? The effect of time pressures on primary care productivity

J Health Econ. 2021 May;77:102442. doi: 10.1016/j.jhealeco.2021.102442. Epub 2021 Feb 23.


This paper examines how time pressure, an important constraint faced by medical care providers, affects productivity in primary care. We generate empirical predictions by incorporating time pressure into a model of physician behavior by Tai-Seale and McGuire (2012). We use data from the electronic health records of a large integrated delivery system and leverage unexpected schedule changes as variation in time pressure. We find that greater time pressure reduces the number of diagnoses recorded during a visit and increases both scheduled and unscheduled follow-up care. We also find some evidence of increased low-value care, decreased preventive care, and decreased opioid prescribing.

Keywords: Health care productivity; Primary care; Provider decision making.

Publication types

  • Research Support, N.I.H., Extramural
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Analgesics, Opioid*
  • Efficiency, Organizational
  • Electronic Health Records
  • Humans
  • Practice Patterns, Physicians'*
  • Primary Health Care


  • Analgesics, Opioid