Poor working conditions for docs may affect quality of care

Jul 8 2009

"Adverse working conditions for primary care doctors, including time pressures and an unfavorable organizational culture, may lead to stress, burnout, and ultimately to lower quality patient care, a new study found," MedPage Today reports.

The study, published in the July 7 issue of The Annals of Internal Medicine, found that "53.1% of primary care physicians reported time pressure during physical examinations, while 48.1% reported chaotic working environments. Only 23.7% felt that quality was strongly emphasized in their practices. ... Moreover, 48.8% described their jobs as moderately or highly stressful, while 26.5% reported burnout, and 30.1% said they were at least moderately likely to leave their practices within two years." The authors wrote that the findings "are disturbing at a time when recruitment and retention in primary care are of major concern."

"The analysis did not find any strong or consistent associations between physician reactions, such as stress or satisfaction, and patient care quality or errors." But "in commenting on this finding -- that adverse working conditions stress physicians but are not notably associated with lower quality care -- the researchers said, "Because adverse work conditions were strongly associated with intent to leave the practice, we speculate that patient care could eventually suffer because of the lack of continuity brought on by the departure of dissatisfied physicians."

"In an accompanying editorial, David Mechanic, PhD, of Rutgers University, addressed the issue of remuneration for primary care physicians. 'Cost control constraints make increased remuneration for primary care unlikely unless income is redistributed from specialists to generalists, which the advantaged class understandably resists.' The future of primary care remains uncertain, and much depends on payment policies and incentives for developing workable frameworks for team efforts and professional responsibility. ... The challenge is to organize one-on-one care as part of an integrated system that serves the needs of both patients and physicians, enhances quality, and keeps costs within reason,' he wrote" (Walsh, 7/7).