Stress and Burnout in Primary Care


Studies show that workplace stress and worker burnout in primary care is on the rise. There is a growing body of evidence showing increasing amounts of recognized stress and burnout. This stress is creating a negative impact on our personal lives, as well as our health. Some medical model researchers believe that this is just an inherent component of our fast-paced western medical/technological world, creating an ignorance and acceptance, as well as an overriding rationalization and resistance to proactively doing something about it. While some may accept this to be true, others are calling for a change. Burnout in the primary care and community healthcare center (CHC) settings in particular, have drawn the attention of many in the industry and is being recognized as a serious issue. Due to the unique mission and structure of CHC’s it is reasonable to hypothesize that the satisfaction of physicians working in this setting, may be different than those of other practice settings. When it comes to burnout and stress in the healthcare industry, we stand to lose precious primary care providers if we don’t apply aggressive innovative approaches that serve to create a warmer and more inviting climate for them, especially in California.

Burnout in the healthcare profession for primary care medical providers is a complex issue. In a study completed in 2011 by the Physician Wellness Services of Minneapolis, MN, and Cejka Search of St. Louis, Mo. It was found that almost two-thirds of physicians identified themselves as being more stressed or burned out than they were three years ago. In another study it was reported that almost half of 7000 U.S. physicians had at least one symptom of burnout, and this sad finding is most commonly seen at the frontlines of care.

The current rates of burnout in the primary care industry play a critical part on the wellbeing of our healthcare system and call for a 911 response. In a recent study, when asked of primary care providers “Have you ever left a position do to stress or burnout?” 14% responded affirmatively (Rosenstein, 2012). The study looked at five areas contributing to the level of stress and its impact for healthcare providers, listing the top three for each contributor. The five areas were; external factors contributing to stress, work-related factors contributing to stress, personal-life related factors contributing to stress, the work related impacts of stress, and the top three personal life-related impacts of the perceived stress. Let’s look at those factors and the potential impacts that may impose on the system and potential issues, including safety, to our healthcare systems.

• The top three external factors cited as causing increased stress to providers included the overall economic pressures, health care reform, and the policies of the Centers for Medicare and Medicaid Services (CMS) policies. (Rosenstein, Figure 1, 2012)

• The top three work-related factors cited as contributing to the stress were paperwork and administrative demands, excessive hours of work, as well as on-call schedules and increased expectations (Rosenstein, Figure 2, 2012).

• The top three personal life-related factors cited as contributing to stress and burnout for providers included not enough relaxation time, the lack of time to devote to fitness and wellness activities, and increasing concerns about work-life balance (Rosenstein, Figure 3, 2012).

• The three top work-related impacts of stress on providers was a lower that average job satisfaction, an expressed desire to work less hours, and a deep desire to retire early. As many as 28% even when as far to express a desire to change careers (Rosenstein, Figure 4, 2012).

• The top three personal life-related impacts of stress were feeling tired, sleep problems, and a generalized feeling of being moody and irritable (Rosenstein, Figure 4, 2012).

By considering the data as presented we can see some very compelling reasons why our primary care providers are losing interest in their profession and the implication’s for our Healthcare Systems. Primary care providers’ level of job satisfaction has been associated with patient outcomes. In a study by Cole, et. al., (2012) it is reported that a higher primary care provider satisfaction is associated with higher patient satisfaction and patient-reported quality of care (Cole, 2012). Conversely, primary care provider dissatisfaction also is associated with increased rates of providers prescribing non-recommended medications. If current trends continue, our inability to recruit and retain qualified primary care providers will impact our healthcare organizations by negatively effecting short and long term productivity and patient safety outcomes, create a decrease in access for patients, and an overall declining experience for primary care providers, ancillary support staff, patients, and all stakeholders in general.

Solutions???? According to Rosenstein (2012) there are three things we can do to begin to help; we can raise awareness, offer support, and be proactive in our own organizations to address stressed workloads and help providers carve out time to practice self-care. Many medical school are approaching this topic and building stress reduction training into the medical school curriculum. While this may help the newbies, what about our future primary care providers, will it be too little too late? What of our current providers already in practice? There is a battle waging in healthcare, creating a cold and gloomy climate between regulatory bodies like CMS, healthcare reform, organizations that are seeking improvements, and the primary care providers themselves. It is not the differences in the work between the four entities that divides us and implores stress on our primary care provider system, it’s our judgments and unrealistic expectations about outcomes that do. The patients that show up are sicker, more complicated, and require more of our resources than ever before. When it comes to burnout and stress in the healthcare industry, we stand to lose precious primary care providers if we don’t apply aggressive innovative approaches that serve to create a warmer and more inviting climate for them than we ever have before. If we want them to be around to take care of us, we must first care for them.  

References
Bowman, M., Neale, Anne Victoria (2014) Family Physicians are complex Care Physicians and Quality of Care Advancement Experts. Journal of the American Board of Family Medicine, 2014; 27: 1-3. doi: 10.3122/jabfm.2014.01.130283.
Cole, A., Doescher, M., Phillips, W., Ford, P., Stevens, N. (2012) Satisfaction of Family Physicians Working in Community Health Centers. The Journal of the American Board of Family Medicine, August 2012, vol 25, no. 4, p. 470-476. doi: 10.3122/jabfm.2012.04.110295
Khanna, Rajeev., Khanna, Rashmi, (2013) Is medicine turning into unhappy profession? Indian Journal of Occupational and Environmental Medicine. April 2013, Vol 17, Issue 1, p. 2-6. Retrieved from Ashford University on 2-28-14.
Rosenstein, A. (2012) Physician Stress and Burnout: What Can We Do? Physician Executive Journal. Nov/Dec 2012, p. 22-30. Retrieved from Ashford University on 2-28-14.
Shannon, Diane (2013) Physician Well-Being: A Powerful Way to Improve the Patient Experience. Physician Executive Journal. July/August 2013, p. 6-12. Retrieved on March 1st, 2014 from http://www.acpe.org/publications/pej

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