Safety Net Clinician Burnout Smolders

RAND survey of physicians and nurses at nearly 300 federally qualified health centers across the nation finds increasing dissatisfaction with work conditions.

Clinicians at safety net community health centers are reporting growing dissatisfaction with their jobs and researchers aren’t exactly sure why, a new RAND Corporation study finds.

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. The survey was taken in 2013 and 2014 and the findings were reporting this month in 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.

“There are several possibilities for the dissatisfaction,” said Katherine Kahn, MD, 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.”

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, burnout, and whether they intended to quit. They also were asked about the level of stress, practice atmosphere, top-of-license activity, and clinic practice culture.

The proportion of respondents reporting high job satisfaction worsened significantly in one year, falling from 82% in 2013 to 74% in 2014. The rate of burnout increased from 23% to 31%, and the proportion of respondents who reported they were likely to leave their jobs increased from 29% to 38%.

Three of five work environment measures worsened, with the proportion of respondents who reported a hectic/chaotic practice atmosphere increasing from 32% to 40%. Twelve of 13 practice culture measures also worsened significantly over time.

The RAND study did not probe the causes of the dissatisfaction, but 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,” said Mark Friedberg, MD, lead author of the study and a senior physician scientist at RAND. “Our findings show that the job stress documented in other settings extends to federally qualified health centers as well.”