Ridiculous Study of the Week: Optimal Primary Care Panel

This one is kind of hilarious. First, the entire abstract:

What Is the Optimal Primary Care Panel Size?: A Systematic Review



Primary care for a panel of patients is a central component of population health, but the optimal panel size is unclear.


To review evidence about the association of primary care panel size with health care outcomes and provider burnout.

Data Sources:

English-language searches of multiple databases from inception to October 2019 and Google searches performed in September 2019.

Study Selection:

English-language studies of any design, including simulation models, that assessed the association between primary care panel size and safety, efficacy, patient-centeredness, timeliness, efficiency, equity, or provider burnout.

Data Extraction:

Independent, dual-reviewer extraction; group consensus rating of certainty of evidence.

Data Synthesis:

Sixteen hypothesis-testing studies and 12 simulation modeling studies met inclusion criteria. All but 1 hypothesis-testing study were cross-sectional assessments of association. Three studies each provided low-certainty evidence that increasing panel size was associated with no or modestly adverse effects on patient-centered and effective care. Eight studies provided low-certainty evidence that increasing panel size was associated with variable effects on timely care. No studies assessed the effect of panel size on safety, efficiency, or equity. One study provided very-low-certainty evidence of an association between increased panel size and provider burnout. The 12 simulation studies evaluated 5 models; all used access as the only outcome of care. Five and 2 studies, respectively, provided moderate-certainty evidence that adjusting panel size for case mix and adding clinical conditions to the case mix resulted in better access.


No studies had concurrent comparison groups, and published and unpublished studies may have been missed.


Evidence is insufficient to make evidence-based recommendations about the optimal primary care panel size for achieving beneficial health outcomes.

Primary Funding Source:

Veterans Affairs Quality Enhancement Research Initiative.

So, their answer for the optimal primary care panel size is………….they have no f$cking clue.


The problem starts right from the beginning. “Primary care for a panel of patients is a central component of population health”. Population health? Here the narrative is being changed to make primary care docs feel that their duty is to control the population. Whatever happened to treating the patient right in front of you?

Next was the supposed purpose of the study: “To review evidence about the association of primary care panel size with health care outcomes and provider burnout.” See how they put health care outcomes in there again? This goes back to population health. All to justify bogus quality metrics. They want us to be cattle herders. Hell, maybe we should just put antibiotics and cholesterol in all the water supply. That would hurt some but help possibly more. That’s population health management, isn’t it?

C’mon, it is obvious that the physician burnout is inversely proportional to administrative drag and panel size. That’s your answer. Idiots.

(And that is what is so great about Direct Primary Care).

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Douglas Farrago MD

Douglas Farrago MD is a full-time practicing family doc in Forest, Va. He started Forest Direct Primary Care where he takes no insurance and bills patients a monthly fee. He is board certified in the specialty of Family Practice. He is the inventor of a product called the Knee Saver which is currently in the Baseball Hall of Fame. The Knee Saver and its knock-offs are worn by many major league baseball catchers. He is also the inventor of the CryoHelmet used by athletes for head injuries as well as migraine sufferers. Dr. Farrago is the author of four books, two of which are the top two most popular DPC books. From 2001 – 2011, Dr. Farrago was the editor and creator of the Placebo Journal which ran for 10 full years. Described as the Mad Magazine for doctors, he and the Placebo Journal were featured in the Washington Post, US News and World Report, the AP, and the NY Times. Dr. Farrago is also the editor of the blog Authentic Medicine which was born out of concern about where the direction of healthcare is heading and the belief that the wrong people are in charge. This blog has been going daily for more than 15 years Article about Dr. Farrago in Doximity Email Dr. Farrago – [email protected] 

  9 comments for “Ridiculous Study of the Week: Optimal Primary Care Panel

  1. Steven Mussey
    February 17, 2020 at 5:31 pm

    The problem is, panel size is meaningless. Ten sick Medicare patients can keep you busier than a thousand fairly healthy younger patients.

  2. R Stuart
    February 17, 2020 at 2:10 pm

    I’ve always wondered if any of the morons at the AAFP would hire someone who practiced “population law” (“Dr. Munger, I’ll be arguing your case in a way so as to obtain a verdict that is most beneficial to society as a whole?) or “population accounting” (“We’ll be filing your tax return so as to address the concerns of all US citizens about the financial future of the country”).

    All I know is that I’ve never had a patient ask me for some “population health.” Which is probably a good thing, as I have absolutely no idea how to do it.

    I think it mainly involves a lot of harassing calls to patients I’ve never seen threatening them with dire consequences if they don’t do what their insurer wants them to do . . .

    • Pat
      February 17, 2020 at 5:48 pm

      Yeah, I could name a couple of mid-20th Century nations that went all-in for “population health”…

  3. Soccerdoc11
    February 16, 2020 at 6:57 pm

    With patient’s dying, moving away, changing doctors, being healthy enough not to see me, I have no idea what my panel size is. Even if I use payor lists, that’s no help with patients on my panel who see an FP in the next state who has the same name as I.

  4. Bill Ameen, MD
    February 16, 2020 at 9:27 am

    I was within a year or two of retirement before I learned that my patient “load” or “cohort” or whatever was actually called a “panel.” How did DPC arrive at the commonly used limit of 600 patients? Is that 600 families or 600 individual patients? Just wondering. I’m still retired except for teaching and volunteer work…and loving it!

    • Douglas Farrago MD
      February 16, 2020 at 2:23 pm

      600 – 700 total. Trial and error

  5. Pat
    February 16, 2020 at 9:07 am


  6. Steve O'
    February 16, 2020 at 8:51 am

    The question is just another version of our Paleolithic ancestors’ thoughts – “What is the best tool? A stick or a rock?” The answer is, of course, that these are instruments to produce a particular effect. For poking, a stick is unmatched; for flinging, go with the stone.
    What Is the Optimal Primary Care Panel Size? sounds a bit like the adolescent insecurity about one’s private parts. The answer is similar – for what purpose do you raise the question? Or more crudely, it ain’t how big it is, it’s what you can do with it. “My primary care panel size is 5! Oh yeah, mine’s 7!!” sounds a bit like locker-room boasting.
    There is a statistically significant correlation between the medical literature and the habit of self-pleasuring, although you will not get arrested in a movie theater for reading JAMA in the dark. The goal, however, seems the same sometimes.

  7. PW
    February 16, 2020 at 8:32 am

    How much grant money was wasted on this BS?

Comments are closed.