In the primary care workplace, clinicians, especially women and general internists, feel pressured that they lack adequate time to provide quality care to patients. This time pressure is positively associated with lack of work control, stress, burnout, and intent to leave the practice, according to results from a study published in the Journal of General Internal Medicine.

To determine the association between time pressure, workplace characteristics, and clinician outcomes, investigators conducted a prospective analysis of data from the Healthy Work Place randomized trial. They included 168 physicians and advanced practice clinicians from 34 primary care practices in the upper Midwest and East Coast.

The primary outcome measured the perceived time pressure during new patient and follow-up visits. Time pressure was defined as a clinician indicating they needed additional time for a particular type of visit, and was measured as needed or not needed. Additional outcomes included lack of work control, work pace, and organizational culture. Clinician outcomes included stress, satisfaction, burnout, and intent to leave the practice.

A total of 67% clinicians indicated that they needed additional time for new patient visits; for new patient visits, the average time allotted was 35.2 minutes, and the average time needed was 45.9 minutes (P <.001). For follow-up visits, 53% of clinicians required more time (23.5 minutes) than was allotted (19.9 minutes). In addition, general internists experienced more time pressure events than family physicians (74% vs 55%, respectively). Prevalence of time pressure was also greater among women than men (78% vs 55%, respectively), as well as among younger clinicians.

Healthcare providers who managed a greater number of psychosocially complex and non-English-speaking (Limited English Proficiency) patients indicated more time pressure than those without these types of patients.

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Time pressure during new appointments was linked to a lack of control, leading to provider stress, and intent to leave the practice. For follow-up visits, time pressure was linked to chaotic work pace and burnout.

“Most [Healthy Work Place] clinicians felt they needed more time with their patients to provide quality care,” the authors noted. “Because our data show that time pressure is associated with workplace chaos and stress, and that quality emphasis and values alignment between clinicians and leaders seem to diminish time pressure, time pressure may be an important and remediable metric in primary care.”


Prasad K, Poplau S, Brown R, et al. Time pressure during primary care office visits: a prospective evaluation of data from the healthy work place study [published online December 3, 2019]. J Gen Intern Med. doi:10.1007/s11606-019-05343-6