Physicians often feel pressed for time during the standard primary care visit. Recent studies have shown that shorter visits are not only common but also lead to unaddressed health issues and a diminished understanding of patient concerns. Thus, it is critical to understand the relationship between time pressure, worklife factors and clinician outcomes such as stress and burnout in order to begin identifying risks and potential solutions.
In a prospective study of data collected as part of a randomized control trial, researchers used a validated measure to assess time pressure and worklife metrics in 168 physicians and advanced practice clinicians (nurse practitioners and physician assistants) in 34 clinics in the Midwest and on the East Coast.
Recently published online in the Journal of General Internal Medicine, this study defined time pressure as the clinician stating they needed more time than allotted for a visit. Clinicians reported that the average time allotted for new patients was 35.2 minutes with 19.9 minutes allotted for follow-up appointments. Sixty-seven percent of clinicians needed more time for new patients while 53% needed more time for follow-up visits. In particular, clinicians felt they needed 10.7 additional minutes with new patients (30% more time needed) and 3.6 additional minutes for follow-up visits (18% more time).
The researchers found time pressure was related to worrisome clinician outcomes such as stress, burnout, and intent to leave ones practice; these data highlight the importance of addressing time pressure, given previous findings that burnout is linked to adverse patient outcomes and intent to leave is linked to turnover with decreased access for patients and loss of practice income.
Higher rates of time pressure were reported in general internists (versus family physicians) and in clinicians with larger numbers of complex patients (complex psychosocial patients, and those with Limited English Proficiency). Time pressure was also more common among female clinicians, who needed 42% more time for new patients versus 20% more time needed by males. Studies have shown women clinicians have lower patient mortality and readmission rates compared to males; these new findings suggest these favorable results may come at a greater personal cost for women clinicians, due to higher time pressures during patient encounters.
Organizational factors were also related to time pressure. The data showed that time pressure was associated with workplace chaos and stress, while organizations emphasizing quality of care and values alignment between clinicians and leaders demonstrated less time pressure.
Time pressure may thus be an important and remediable metric in primary care which warrants further study.
Mark Linzer, MD, PI, from Hennepin Healthcare, and colleagues at University of Minnesota, University of Wisconsin, Loyola University, Cambridge Health Alliance, University of Central Florida, and University of Alabama. This project was supported by grant number R18HS018160 from the Agency for Healthcare Research and Quality. The content is solely the responsibility of the authors and does not necessarily represent official views of the Agency for Healthcare Research and Quality.
About the Hennepin Healthcare Research Institute
Hennepin Healthcare Research Institute (HHRI) is the research arm and a nonprofit subsidiary of Hennepin Healthcare System, Inc., a comprehensive health system in Minneapolis. HHRI is one of the largest nonprofit medical research organizations in Minnesota and consistently ranks in the top 10 percent of all institutions receiving research funding from the National Institutes of Health.
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