Insufficient working conditions in primary care are associated with adverse physician reactions.

Studies publishes in the July 2009 issue (Volume 151 Issue 1 | Pages 28-36) of Annals of Internal Medicine suggest that adverse primary care work conditions could lead to a reduction in the primary care workforce and lower-quality patient care.

However, the study could not conclude whether adverse work condition and adverse physician reaction would have any impact on the quality of patient care.

Researchers studied 422 family practitioners and general internists at 119 clinics and the results include:

  • 53.1% of physicians reported time pressure during office visits,
  • 48.1% said their work pace was chaotic,
  • 78.4% noted low control over their work,
  • 26.5% reported burnout.

Adverse workflow (time pressure and chaotic environments), low work control, and unfavorable organizational culture were linked with low physician satisfaction, high stress, burnout, and intent to leave. Some work conditions were associated with lower quality and more errors, however, findings were inconsistent. No association was found between adverse physician reactions, such as stress and burnout, and care quality or errors.

What perturbs me about this study is the following:

Half of all the physicians found that they felt under pressure during office visits and their work pace was chaotic. My question is, how can this be a nurturing and healing environment for sick patients? How do they want a patient to open up and share – sometimes embarrassing and sometimes very intimate information – when the patient feels the tense and impatient energy in the physician?

One in four physicians reported burnout, which means they are suffering from a debilitating psychological condition that drained their energy, increased their depersonalization in interpersonal relationships and increased their dissatisfaction.
One in four physicians!!! Is anybody in healthcare listening to this?

Would we allow pilots or air traffic controllers work under these circumstances?

  • What improvements will healthcare organization do now that are based on these findings?
  • How will primary care physicians adjust their work flow and work environment to improve their job satisfaction?
  • What proactive measures will they take to reverse burnout and possibly prevent it?

My guess is considering that there was “no consistent association between adverse work conditions and the quality of patient care”, this study won’t be taken into any consideration to make any significant improvements. Instead it might get used as an excuse to forego an examination of working conditions of doctors and recommend any necessary changes. As long as doctors perform at an acceptable level and their dissatisfaction and burnout doesn’t affect the quality of patient care, I assume that nobody sees the need to do something about it. Does that mean “mediocrity is still king?”

Studies are done to make improvements; the time to do them is right now. Physician coaching is a perfect tool to lead the improvement.

To read more details about the study, go to http://www.annals.org/cgi/content/abstract/151/1/28