Time Spent By Multiple Sclerosis Providers in Direct and Indirect Patient Care and the Burden of Portal Messages

Background: The prevalence of MS is increasing in the face of a shortage of MS specialists in the US. Clinic visits for MS patients are time consuming. Portal messages facilitated by the EMR have increased access to providers and improved quality and timeliness of care for MS patients, but also increased provider demands. Patient care time outside of clinic is often underreported and uncompensated and data on time spent by MS providers both in direct and indirect patient care is lacking.

Objectives: To understand practice patterns among MS providers in the US and time spent in direct and indirect patient care and compensation for portal messages.

Methods: Following institutional approval, the NMSS and the AAN facilitated distribution of Survey Monkey to MS providers. Providers were asked about current profession, type of practice, availability of support staff, time dedicated to MS care, time spent in clinic with new and follow-up patients, time spent in direct and indirect patient care, and whether time spent on portal messages was compensated.

Results: Most respondents were physicians and the majority practiced in an Academic Center or an Academic affiliated MS Center. The majority had nursing or medical assistant supports. Less than half had social work or psychologist support. Most providers spent at least one hour with a new patient and at least 30 minutes with a follow-up. Time spent daily in indirect patient care tended to be long for most providers (77% spent more than 1 hour and 57% spent more than 2 hours per day on indirect patient care). Few participants were compensated for time spent responding to messages and only 31% had dedicated support staff to respond to messages

Conclusions: This survey captured a well-representative sample of MS providers, the majority of which spent more than half their time in a clinic dedicated to MS care. The results of the survey confirm that time spent dedicated to MS patient care is high, with most respondents spending above average time in clinic with new and returning patients. Despite the presence of support staff in many MS practices, most providers spent at least one hour per day (and more than half spent at least two hours) in indirect patient care. Few MS specialists in this survey had dedicated support staff to assist in responding to portal messages and even fewer had protected time or were compensated for their time spent responding to messages. As the complexity of disease management continues to grow, usage of patient portal messages is expected to continue to expand. While larger systematic studies may be needed to confirm our findings, these results highlight the potential impact of indirect patient care (notably portal messages) on physician burnout. We hope that our results move the conversation forward on ways healthcare systems can support, protect and compensate providers for their indirect time with patients so that they can continue to deliver the highest quality, patient-centered neurologic care.