Time pressure and a chaotic work environment may be among the adverse work conditions to blame for the decrease in primary care physicians, with the overall shortage of doctors in the United States estimated to reach 124,400 by 2025. More than half of the physicians (53.1 percent) surveyed 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, according to the report in the Annals of Internal Medicine.

The researchers with the Loyola University Chicago Stritch School of Medicine say 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 they say findings were inconsistent across work conditions and medical diagnoses.

“Unfavorable work conditions are associated with stress, burnout, and intent to leave for primary care physicians,” says study author Anita Varkey, 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.”

What’s worrisome is that already there are not enough primary care physicians to meet current needs, says 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,” she says.

Researchers surveyed 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. They asked participants about perception of clinic workflow (time pressure and pace), work control, organizational culture, physician satisfaction, stress, burnout, and intent to leave practice.

The researchers conclude that interventions in primary care clinics should target measures to reduce physician burnout, clinic chaos, and work control measures. They add that 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, healthcare reform strategies should consider the role that work environment plays in physician job satisfaction and quality of patient care,” she says.