Chaotic working conditions wear down primary care physicians

Pressured pace, lack of control linked to low satisfaction, high stress and burnout, a new study reports.

By Susan J. Landers — Posted Aug. 3, 2009

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A chaotic work environment -- with insufficient time for proper patient care and lack of control over work -- takes a toll on primary care physicians.

More than half of these physicians feel time pressure during office visits, while 48% said their work pace is chaotic and 78% said they have little control over their work. The analysis of 422 family physicians and general internists in 119 clinics was reported in the July 7 Annals of Internal Medicine (link).

These conditions were strongly associated with low physician satisfaction, high stress, burnout and intent to leave, the study's researchers said.

Health system reform efforts to provide coverage to the uninsured make it especially important to attract and retain primary care physicians, say researchers and health policy experts.

"A major issue in health reform is who is going to care for those [47] million uninsured people, so recruitment and retention in primary care is a major issue for the country," said study lead author Mark Linzer, MD, professor of medicine at the University of Wisconsin School of Medicine and Public Health in Madison.

Working conditions speak volumes

An annual Assn. of American Medical Colleges survey of graduating medical students found that the biggest factor in selecting a specialty is how well it matches student expectations of a satisfying career.

"It's not just that primary care pays less, but it's also the fact that people don't like what they see when it comes to the daily practice of primary care right now," said Atul Grover, MD, PhD, chief advocacy officer of the AAMC.

Students notice when teaching hospitals invest in facilities for lucrative specialties but not for primary care, according to a perspective written by Robert Steinbrook, MD, in the June 25 New England Journal of Medicine (link).

"During specialty rotations, students may observe well-managed offices with spacious modern facilities, in contrast to crowded older primary care clinics with harried physicians," he wrote.

The Annals study offers some solutions to easing a stressful work environment, including eliminating chaos and disorganization in the workplace, said co-author Linda Manwell, an epidemiologist at the University of Wisconsin medical school. Fixing the system won't be easy, but it is doable, Dr. Linzer said.

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