More than half of primary care physicians report stressful working conditions
Research Activities, December 2009, No. 352
Primary care physicians are not having an easy time at work these days. According to a new study on working conditions, more than half report feeling stressed over time pressures during office visits. They also report other stress-related problems that affect their daily practice. However, the good news is that while these physicians report stress, their reactions to it do not affect the quality of care they provide to patients.
Researchers surveyed 422 family physicians and general internists who worked in 119 ambulatory care clinics located in New York City, Chicago, Milwaukee, Madison, and rural Wisconsin. They also surveyed 1,795 patients from these clinics and reviewed their medical records for information on care quality and medical errors. More than half (53.1 percent) of the physicians reported experiencing time pressures when conducting physical examinations. Nearly a third (30.3 percent) felt they needed at least 50 percent more time than was allotted for this patient care function. In addition, 21.3 percent said they needed at least 50 percent more time for followup appointments.
Time pressure was strongly associated with feelings of dissatisfaction, stress, burnout, and intent to leave the practice. Nearly half of the physicians (48.1 percent) reported chaotic environments. A minority (21.6 percent) felt they had moderate control over their work environment. Despite these survey responses, chart review data produced an average overall quality score (average proportion of quality outcomes for all patients across clinics) of 57.8 percent and an average error score (average proportion of processes of care missing from care of all patients across clinics) of only 33.5 percent.
According to the researchers, physicians may act as buffers between adverse work conditions and patient care, as their reactions do not appear to translate into lower quality care. However, some direct relationships were seen between adverse work conditions and some patient outcomes. These findings require further study, and could provide a link between the primary care work environment and quality of care. The study was supported by the Agency for Healthcare Research and Quality (HS11955).
See "Working conditions in primary care: Physician reactions and care quality," by Mark Linzer, M.D., Linda Baier Manwell, M.S., Eric S. Williams, Ph.D., and others, in the July 7, 2009, Annals of Internal Medicine 151(1), pp. 28-36.