Primary care clinicians, staff increasingly dissatisfied with working conditions

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 - Burnout

Clinicians and staff at 296 clinical sites participating in CMS’s Advanced Primary Care Demonstration were surveyed on 21 different measures of professional satisfaction, work environment and practice culture between 2013 and 2014. On almost every measure, they reported “significant declines” in another sign of burnout among healthcare professionals.

The study, written by RAND Corporation researchers and published in the August 2017 issue of Health Affairs, was two “waves” of surveys to three clinicians and three staff members selected randomly at each site in the demonstration. The first wave was fielded between April and August 2013, with the same respondents included in the late survey wave between June and October 2014. Overall, 236 clinicians and 328 staff members responded.

In all, the survey included 21 total measures: three on professional satisfaction, five on work environment and 13 on practice culture. Between the two surveys, no improvement was seen on any of the measures, while no significant difference being seen on three of the 21. On all the rest, the scores declined, suggesting working conditions had deteriorated recently.

Here are some of the more notable changes in measures between the early and late surveys

  • Overall satisfaction declined from 84.2 percent to 74.4 percent.
  • Burnout increased from 23 percent to 31.5 percent.
  • Intent to leave practice within 2 years increased from 29.3 percent to 38.2 percent.
  • Feeling time pressure on new patient visits increased from 33.9 to 40.3 percent.
  • Confidence in a practice’s ability to adapt with teamwork declined from 68.1 percent to 64.1 percent.

The authors said the stress on a practice of applying for medical home recognition, as the demonstration required, may have increased the risk of burnout on already-understaffed safety-net clinics. Other factors which go beyond the surveyed clinics may have to been to blame, including adopting new electronic health record systems and increased demand after the gains in health coverage under the Affordable Care Act.

“As additional health system changes accumulate under the Medicare Access and CHIP Reauthorization Act of 2016 and new legislative and regulatory activity, policy makers should consider further study of how these forces could affect primary care working conditions—especially in (federally-qualified health clinics) and other safety-net clinics,” the study concluded.