Wednesday, July 8, 2009

Health Clinic Conditions May Be to Blame for Decrease in Primary Care Physicians

New Study Evaluates Role of Clinic Environment on Physician Job Satisfaction

MAYWOOD – Adverse work conditions may be to blame for the decline in the number of primary care physicians nationwide, according to a study published in the latest issue of the Annals of Internal Medicine.

“Unfavorable work conditions are associated with stress, burnout and intent to leave for primary care physicians,” said Dr. Anita Varkey, study author and assistant professor in the department of medicine, Loyola University Chicago Stritch School of Medicine. “These factors contribute to poor job satisfaction, which is among the reasons we are seeing a decrease in the number of primary care physicians.”

The Association of American Medical Colleges estimates that the overall shortage of doctors may grow to 124,400 by 2025.

“There are not enough primary care physicians to meet current needs,” said Varkey, who also is medical director of the general medicine clinic at Loyola Outpatient Center, Loyola University Health System. “These findings suggest that a chaotic clinic environment may further exacerbate this problem and potentially lead to lower quality of patient care due to physician turnover and lack of continuity in care.”

Data for this study were collected from 422 family practitioners and general internists and 1,795 of their adult patients with diabetes, hypertension or heart failure at 119 clinics in New York and the Midwest. Study participants were asked about perception of clinic workflow (time pressure and pace), work control, organizational culture, physician satisfaction, stress, burnout and intent to leave practice.

More than half of the physicians (53.1 percent) reported time pressure during office visits, 48.1 percent said their work pace was chaotic, 78.4 percent noted low control over their work and 26.5 percent reported burnout. Adverse workflow (time pressure and chaotic environments), low work control and unfavorable organizational culture were strongly associated with low physician satisfaction, high stress, burnout and intent to leave. Some work conditions also were associated with lower quality of patient care and more errors, but findings were inconsistent across work conditions and medical diagnoses.

The authors indicated that interventions in primary care clinics should target measures to reduce physician burnout, clinic chaos and work control measures. A healthier workplace for physicians may result in better recruitment and retention of primary care physicians, which may then translate to higher quality patient care.

"While further research is needed, health care reform strategies should consider the role that work environment plays in physician job satisfaction and quality of patient care," Varkey added.

Varkey is an internist who specializes in primary care, preventive medicine and women's health. She sees patients at Loyola Outpatient Center.

Co-authors of the Archives study include Linda Baier Manwell, M.S.; James A. Bobula, Ph.D.; Dr. Mark Linzer, Roger L. Brown, Ph.D., all of the University of Wisconsin-Madison; Dr. Ann Maguire of Medical College of Wisconsin; Dr. Bernice Man of Rush Medical College; Dr. Julia McMurry of William S. Middleton Memorial Veterans Hospital; Eric S. Williams, Ph.D., of the University of Alabama; Dr. Barbara A. Horner-Ibler, of the University of Wisconsin-Milwaukee; and Dr. Mark D. Schwartz of Veterans Affairs New York Harbor Healthcare System.


About Loyola University Health System

Loyola University Health System (LUHS) is part of Trinity Health. Based in the western suburbs of Chicago, LUHS is a quaternary care system with a 61-acre main medical center campus, the 36-acre Gottlieb Memorial Hospital campus and more than 30 primary and specialty care facilities in Cook, Will and DuPage counties. Loyola University Medical Center’s campus is conveniently located in Maywood, 13 miles west of Chicago’s Loop and 8 miles east of Oak Brook, Ill. At the heart of the medical center campus is a 559-licensed-bed hospital that houses a Level 1 Trauma Center, a Burn Center and the Ronald McDonald® Children's Hospital of Loyola University Medical Center. Also on campus are the Cardinal Bernardin Cancer Center, Loyola Outpatient Center, Center for Heart & Vascular Medicine and Loyola Oral Health Center as well as Loyola University Chicago Stritch School of Medicine, Loyola University Chicago Marcella Niehoff School of Nursing and the Loyola Center for Fitness. Loyola's Gottlieb campus in Melrose Park includes the 255-licensed-bed community hospital, the Professional Office Building housing 150 private practice clinics, the Adult Day Care, the Gottlieb Center for Fitness, Loyola Center for Metabolic Surgery and Bariatric Care and the Loyola Cancer Care & Research at the Marjorie G. Weinberg Cancer Center at Melrose Park.

Trinity Health is a national Catholic health system with an enduring legacy and a steadfast mission to be a transforming and healing presence within the communities we serve. Trinity is committed to being a people-centered health care system that enables better health, better care and lower costs. Trinity Health has 88 hospitals and hundreds of continuing care facilities, home care agencies and outpatient centers in 21 states and 119,000 employees.