Quality-of-care concerns add to doctors' stress

Well-designed improvement initiatives may help physicians feel less isolated or dissatisfied, a Massachusetts study says.

By Kevin B. O’Reilly — Posted Aug. 31, 2009

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As many as a third of doctors are dissatisfied with their work, stressed and burned out by increasing workloads and declining pay. But physicians' well-being also is affected by the quality of care their practices deliver, according to a new study.

The results of a statewide survey of nearly 1,900 Massachusetts doctors published in the August Medical Care showed that 31% felt stressed, 27% were dissatisfied with their work and 17% felt isolated from colleagues. Doctors who said their practices had quality problems were more likely to feel stressed.

However, doctors who reported that their practice not only implemented quality initiatives but evaluated their effectiveness were less likely to feel isolated, stressed and dissatisfied, the study said. For example, doctors in practices engaged in quality activities were 44% less likely to feel isolated and 27% less likely to experience work-life stress. The study contradicts earlier findings showing that quality initiatives can increase doctor dissatisfaction.

"Physicians feel more positive about their work when they are in an environment that they feel is doing research to improve," said study lead author Mariah A. Quinn, MD, MPH, a clinical instructor in the Harvard Medical School Dept. of Medicine. "When physicians see that quality initiatives are really rigorously assessed in the practice that's when they feel the practice is doing a good job."

Involving physicians

Quality initiatives targeting chronic disease management or medication safety will be more effective and improve doctor satisfaction if practices seek physicians' input when designing and implementing them, Dr. Quinn said.

Practices should avoid "quality improvement activities that are top-down, managerial-type activities that are just imposed," said Dr. Quinn, an internist in Harvard Vanguard Medical Associates, a multispecialty group practice.

When practices evaluate the effectiveness of interventions, they are more likely to be "examining carefully what components are needed to carry out the improvements," she added. "They'll see the different people who are needed to carry out the improvement piece so that it is not all falling on the heads of physicians."

Dr. Quinn said physician groups large enough to invest in quality activities should see them as not only improving care but potentially helping to reduce costly physician turnover. Payers also should prioritize quality as a way of keeping doctors happy, she said.

"You might avert bad outcomes and keep people healthier longer when you do these kinds of things because there is less discontinuity related to physician turnover," Dr. Quinn said. "Payers could see some two-fer benefit out of this."

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External links

"The Relationship Between Perceived Practice Quality and Quality Improvement Activities and Physician Practice Dissatisfaction, Professional Isolation, and Work-Life Stress," abstract, Medical Care, August (link)

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