Time is up: increasing shadow price of time in primary-care office visits.

A physician's own

time

is a scarce resource in

primary care

, and the physician must constantly evaluate the gain from spending more

time

with the current patient against moving to address the health-care needs of the next.

We formulate and test two alternative hypotheses. The first hypothesis is based on the premise that with

time

so scarce, physicians equalize the marginal value of

time

across patients. The second, alternative hypothesis states that physicians allocate the same

time

to each patient, regardless of how much the patient benefits from the

time

at the margin.

For our empirical work, we examine the presence of a sharply

increasing

subjective

shadow

price

of

time

around the 'target'

time

using video recordings of 385

visits

by elderly patients to their

primary care

physician. We structure the data at the 'topic' level and find evidence consistent with the alternative hypothesis. Specifically,

time

elapsed within a visit is a very strong determinant of the current topic being the 'last topic'.

This finding implies the physician's

shadow

price

of

time

is rising during the course of a visit. We consider whether dislodging a target-

time

mentality from physicians (and patients) might contribute to more productive

primary care

practice.