Doctors say clinics with high minority populations often short on supplies, time

Primary care clinics that care for a large number of minority patients often have a hectic work environment, poor resources and challenging patients, according to a study in the Feb. 9 Archives of Internal Medicine.

Physicians at clinics serving primarily minority patients were four times more likely to report a "chaotic" work environment and half as likely to be satisfied with their jobs than at clinics that serve mostly nonminority patients. Physicians said they had less control over their work -- such as patient volume and scheduling -- than did their counterparts at clinics serving fewer minorities. There also was a trend toward inadequate time with patients.

"I was really surprised that it was four times as much," said the study's lead author, Anita B. Varkey, MD, assistant professor of medicine at Loyola University Health System in Maywood, Ill. "I'm not sure we had a good sense of the magnitude before the study."

The results came from surveys of managers, patients and 388 primary care physicians at 96 clinics in New York, Chicago and Wisconsin that serve various numbers of minority patients. Twenty-seven clinics had a patient base of 30% or more minorities, while the other clinics had fewer than 30% minority patients.

Clinics that treated a higher proportion of minorities reported less access to medical supplies, pharmacy services and referral specialists. Physicians from these clinics reported fewer examination rooms, and said their patients report more chronic pain and often struggle with substance abuse.

Physicians also said they had less written educational materials for patients with hypertension and congestive heart failure, and classified their patients more often as medically and socially challenging.

Better reimbursement for primary care and more access to health insurance could help improve the environment at clinics serving larger numbers of minorities, the study said (link).

More studies on work environment and quality of care should be done, Dr. Varkey said. "We want to better understand whether any of what we have found has any measurable impact on the quality of care patients are receiving in these clinics. We don't know that yet. We know the physicians feel more challenged and patients know these challenges are going on, but we don't know that it translates into the level of quality of care."