A Patient Panel Reallocation Model Incorporating Health Workload Equity

Abstract

Primary care workforce shortages and limitations in how productivity is measured within clinical settings have created challenges for an equitable distribution of physician work in primary care patient panels. The extant literature includes a range of studies that address patient allocation across primary care panels, but these have focused on balancing patient demand and physician capacity, while giving limited attention to workload equity and the validity of workload measurement. Using 2014 physician–patient panel data from a large healthcare system in Washington State, this study developed an equity-oriented framework linking workload measurement with patient panel reassignment optimization. Regression analyses were used to evaluate the extent to which Relative Value Unit (RVU) and risk score capture physician workload across adult and pediatric primary care panels. An equity-adjusted workload measure was then developed to assess workload inequity, and an optimization model was constructed to improve workload equity through within-clinic patient reassignment. Following optimization, workload inequity decreased by 80% among adult panels and 19% among pediatric panels. The findings also revealed important differences in how workload measures perform across adult and pediatric settings. These findings suggest that incorporating workload equity into panel management may reduce workload disparities within existing resource constraints.