August 7, 2017
Physicians, nurses and other staff members at medical clinics that care for people from lower-income communities are increasingly dissatisfied with their jobs, adding to evidence that the health care workforce is under stress, according to a new RAND Corporation study.
Declines across most measures of professional satisfaction, work environment and practice culture were reported among both clinicians and staff in a national sample of federally qualified health centers, according to findings published in the August edition of the journal Health Affairs.
RAND surveyed clinicians and staff whose federally qualified health centers participated in a national demonstration that was designed to help them become patient-centered medical homes. Medical homes are primary care practices that provide comprehensive, personalized, team-based care using patient registries, electronic health records and other advanced capabilities.
“Things appear to have gotten worse over a short period of time at clinics that serve many of the nation's poorest and sickest patients, and we're not sure why,” said Dr. Mark Friedberg, lead author of the study and a senior physician scientist at RAND, a nonprofit research organization. “This merits more attention.”
“There are several possibilities for the dissatisfaction,” said Dr. Katherine Kahn, the study's principal investigator and Distinguished Chair in Health Care Delivery Measurement and Evaluation at RAND, and a professor at the David Geffen School of Medicine at UCLA. “For example, rapid adoption of new electronic health record systems can disrupt practice workflow and distract from face-to-face care. Also, many clinics were simultaneously trying to become a medical home while also participating in other initiatives.”
Federally qualified health centers are community-based organizations that provide comprehensive primary care and other health services to people of all ages, regardless of their ability to pay or whether they have health insurance. Such clinics are eligible for support from the federal government and are considered a linchpin of the nation's medical safety net.
RAND researchers surveyed clinicians and staff from 296 federally qualified health centers across the nation in both 2013 and 2014 about their work conditions. A total of 564 doctors, nurses, and staff members completed both of the surveys.
Participants were asked about their overall professional satisfaction, whether they faced “burnout,” and whether they intended to leave their jobs. They also were questioned about aspects of their work environment, such as the level of stress, practice atmosphere, and top-of-license activity, and they were queried about their clinic's practice culture.
The proportion of respondents reporting high job satisfaction worsened significantly over time, falling from 82 percent in 2013 to 74 percent in 2014. The rate of burnout increased from 23 percent to 31 percent, and the proportion of respondents who reported they were likely to leave their jobs increased from 29 percent to 38 percent.
In addition, three of five work environment measures significantly worsened over time, with the proportion of respondents who reported a hectic/chaotic practice atmosphere increasing from 32 percent to 40 percent. Twelve of 13 practice culture measures also worsened significantly over time.
While the RAND study did not probe the causes of the dissatisfaction, researchers say their findings are consistent with research in other types of clinics, which has shown an increase in rates of clinician burnout nationwide.
“This is more evidence that we are in a challenging time for health care providers and their staffs,” Friedberg said. “Our findings show that the job stress documented in other settings extends to federally qualified health centers as well.”
Support for the study was provided by the Centers for Medicare and Medicaid Services. Other authors of the study are Dr. Rachel O. Reid, Dr. Claude Setodji, Aaron Kofner, Beverly Weidmer and Dr. Justin W. Timbie.
RAND Health is the nation's largest independent health policy research program, with a broad research portfolio that focuses on health care costs, quality and public health preparedness, among other topics.