With the advent of an increasing aging population, physicians and other healthcare providers are seeking alternative approaches in offering patients access to quality health care.  Among the innovations in healthcare delivery is the practice of shared medical appointments, where one or more healthcare providers (e.g. physicians and nurses) will see a group of eight to 15 patients with similar medical conditions at the same time.

The New York Times reported that early studies found the shared appointment approach to be most successful in managing chronic illnesses, such as diabetes or heart disease; however, the model has been implemented for other conditions.  According to the American Academy of Family Physicians, the popularity of shared medical appointments have doubled since 2005, increasing from 5.7 percent to 12.7 percent in 2010.

Structure of Visits

During a typical shared medical appointment session, a group of patients are seen together by a healthcare team, usually consisting of a physician and one or more nurses.  The group sessions normally run about 90 minutes to two hours (compared to traditional physician office visits which usually last about 15 to 30 minutes) and are structured to encourage patients to asks questions, share their experiences and concerns, and provide support and motivation to one another.  Although patients are not required to share information at a group session, each of them must sign a confidentiality agreement, promising not to disclose any information discussed at the meeting.

During a group session, a physician might conduct physical examinations, such as taking weight measurements, while nurses may assist with vitals and refilling prescriptions.  Physicians will also answer any questions and facilitate discussions of medical issues.  Group sessions vary in the frequency in which they are held, with some meetings occurring weekly, biweekly, or monthly.

Patients who attend shared medical appointments are not barred from individual visits with their physicians and can schedule individual appointments if necessary or desired.

Benefits of Shared Medical Appointments

The group appointment model contains numerous benefits for patients and physicians.  In enabling physicians to treat more patients, the model can be viewed as a potential way to address the impending physician shortage.  According to a study published in the Annals of Family Medicine in December 2012, an additional 52,000 primary care physicians are required in order to meet the country’s healthcare needs by 2025.  The increased demand for physicians is primarily driven by population growth and, to a lesser extent, by America’s aging population and insurance expansion as a result of the Affordable Care Act.

Additionally, studies have shown that group visits can improve patients’ health outcomes.  An Italian study found shared medical appointments to improve health outcomes for Type II Diabetes patients, including lower blood glucose, blood pressure, cholesterol, and body mass indexes.  In Boston, the Joslin Diabetes Center experimented with shared medical appointments with optimistic results: nearly 500 people averaged 20 pounds of weight loss and had more success maintaining that weight loss, reducing their need for medication.

Furthermore, the shared medical appointment approach benefits patients by providing them with an opportunity to spend more time with their healthcare provider(s), and obtain more information that will allow them to better improve and protect their health.  The benefits patients receive from shared medical appointments come at little cost to them personally.  Shared appointments are typically covered by insurance in the same way as traditional individual appointments, with generally no difference in copay.  Insurers, for the most part, focus on the level of care provided rather than the setting in which it is provided or the number of patients being treated.

From a physician’s perspective, the shared appointment approach allows for increased efficiency as physicians are relieved from having to repeat the same advice such as maintaining stable glucose levels and lowering blood pressure to numerous patients individually.  Instead, these messages can be conveyed to the group of patients at the same time.

Cautions to Consider

The Cleveland Clinic, which began offering shared medical appointments over 10 years ago, cautioned that shared appointments may not be the right approach for every patient and in every situation.  Some criticisms of the model include the following:

  • Physicians assume less of an authoritative role and act more like a facilitator for patient-driven discussion;
  • Some patients are not comfortable with the group setting and/or sharing personal health information in such setting; and
  • Some physicians are uncomfortable with this model and view it as a means in which physicians can increase profits by being able to treat more patients at the same time and as a means of cost-savings at the expense of individual patients.

Additional resources:

Cleveland Clinic. Shared Medical Appointments. http://my.clevelandclinic.org/patients-visitors/prepare-appointment/shared-medical-appointments

Kaiser Health News. Group Appointments with Doctors: When Three Isn’t a Crowd. http://khn.org/news/031913-michelle-andrews-on-group-patient-appointments/

NPR. The Doctor Will See You and a Dozen Strangers Now. http://www.npr.org/sections/health-shots/2013/03/18/174663545/the-doctor-will-see-you-and-a-dozen-strangers-now

Trento, M., et al. Rethink Organization to iMprove Education and Outcomes (ROMEO) http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2845019/

Annals of Family Medicine.  Projecting US Primary Care Physician Workforce Needs: 2010-2025



Original article:

Group Doctor Visits Gain Ground (NYT 05/06/2016)