the health strategist
research institute for health strategy
and digital health
Joaquim Cardoso MSc.
Chief Research and Strategy Officer (CRSO),
Chief Editor and Senior Advisor
August 17, 2023
What is the message?
Primary care physicians around the world say they are overworked, demoralized, and undervalued.
Primary care physicians in 10 high-income countries report that they spend too much time on administrative work and not enough time with their patients.
Key takeaways:
Primary Care Physicians Under Strain: Primary care physicians in high-income countries, including the U.S., are experiencing dissatisfaction and burnout due to various stressors, including the COVID-19 pandemic.
- A significant number of physicians are leaving the workforce due to retirement, burnout, and other stress-related reasons.
Dissatisfaction Factors: Many primary care physicians reported dissatisfaction with their work due to increased workload, reduced time with patients, administrative burden, and financial concerns.
- The pandemic further exacerbated these challenges, leading to a decline in the quality of care provided by some physicians.
Impact of the Pandemic: The COVID-19 pandemic caused a substantial shift towards telehealth visits, resulting in decreased in-person visits and associated revenue drops for some physicians.
- Moreover, the pandemic added to the administrative burden and overall stress levels of primary care physicians.
Global Discontent: Across the surveyed countries, a majority of primary care physicians expressed dissatisfaction with various aspects of their medical practice, including income, time with patients, daily workload, administrative work, and work-life balance.
Quality of Care Concerns: Even among the satisfied physicians, over a third in several countries reported a decline in the quality of care due to the pandemic.
- Patient care was impacted by the limited time available for interactions and the growing administrative tasks.
Time Constraints: Primary care physicians faced challenges in dedicating sufficient time to each patient, with many reporting spending less than 15 minutes with patients.
- The limitations in time hindered the ability to provide comprehensive care and adhere to care guidelines.
Administrative Burden: The majority of physicians across all countries expressed dissatisfaction with spending excessive time on administrative work, including electronic health record maintenance.
Work-Life Balance: A significant majority of primary care physicians in almost all countries reported dissatisfaction with their work-life balance, contributing to stress and burnout.
Solutions and Implications: Reducing physician workloads and streamlining administrative tasks are highlighted as potential solutions to increase satisfaction and reduce burnout.
- Strategies such as restructuring reimbursement models and adopting value-based care approaches could help improve primary care conditions.
Global Crisis in Primary Care: The study underscores the global crisis in primary care, emphasizing the need to address physician dissatisfaction and burnout to ensure high-quality patient care.
Data Collection: The findings are based on the 2022 Commonwealth Fund International Health Policy Survey of Primary Care Physicians, which assessed physicians’ perspectives on their work, job satisfaction, and challenges in 10 high-income countries.
- In conclusion, the study highlights the significant challenges faced by primary care physicians in multiple high-income countries, leading to widespread dissatisfaction and burnout.
- The COVID-19 pandemic exacerbated these issues, revealing the urgent need to address these concerns to ensure the provision of quality patient care.
Infographic:
DEEP DIVE
Overworked and Undervalued: Unmasking Primary Care Physicians’ Dissatisfaction in 10 High-Income Countries
Findings from the 2022 International Health Policy Survey
The Commonwealth Fund
Evan D. Gumas, Munira Z. Gunja, Arnav Shah, Reginald D. Williams II
August 16, 2023
A medical student strikes in Lyon, France, on Nov. 17, 2022, to protest a one-year extension of general practitioner training in areas that suffer from a shortage of medical personnel. In a Commonwealth Fund survey, less than half of primary care physicians in eight of 11 countries were satisfied with their medical practices overall. Photo: Jeff Pachoud/AFP via Getty Images
Introduction
In many countries, including the United States, primary care physicians are reaching a breaking point.1 In 2021, an estimated 117,000 physicians in the U.S. left the workforce for reasons like retirement, burnout, and pandemic-related stressors.2 During the COVID-19 pandemic, primary care physicians around the world saw a dramatic fall in in-person visits in favor of telehealth, accompanied in some countries by decreases in revenue.3 The Commonwealth Fund also found that most primary care physicians experienced increases in their workload because of more time spent processing insurance payments, getting patients medications or treatments because of coverage restrictions, and reporting clinical or quality of care data to external entities. This has contributed to increased stress, emotional distress, demoralization, and burnout.4
This brief explores primary care physician work satisfaction in the first year of the pandemic — 2020 to 2021 — drawing from the 2022 Commonwealth Fund International Health Policy Survey of Primary Care Physicians. (See “How We Conducted This Survey” for more details.) Understanding how primary care physicians feel about their everyday work is crucial to improving their patients’ quality of care and to reversing the steady stream of professionals exiting the primary health care workforce. Across 10 high-income countries, including the U.S., we compare primary care physicians’ time spent with patients, number of patients seen, and job satisfaction.
Highlights
- The majority of primary care physicians in most surveyed countries were not satisfied with their work.
- Even among those who were satisfied, more than a third of primary care physicians in half of the surveyed countries reported decreases in the quality of care they were able to provide.
- Less than a third of primary care physicians in all countries were satisfied with the amount of time they were able to spend with patients.
- More than 90 percent of primary care physicians in all countries felt they spent too much time on administrative work.
- More than three-quarters of primary care physicians in almost all countries were dissatisfied with their work–life balance.
Survey Findings
In seven of 10 surveyed countries, less than half of primary care physicians reported being satisfied overall with their medical practice — meaning they were “extremely” or “very” satisfied with a number of aspects of their work, including income, time spent with each patient, daily workload, time spent on administrative work, and work–life balance.
Of the primary care physicians who were satisfied with aspects of their practice during the pandemic, many reported not being able to provide the same level of care as they had prior to its onset. In half the surveyed countries, more than a third reported the quality of care they provide patients had worsened.
In all surveyed countries, less than half of primary care physicians reported being satisfied with their income, with Australia and the U.K. reporting the lowest rates of satisfaction.
Primary care physicians in the U.S. receive among the lowest average compensation by specialty, roughly 44 percent less than specialists in 2023. While their salaries increased up to 4 percent, depending on their field of practice, the highest-earning specialty, oncology, saw salary growth of as much as 13 percent.5
Most primary care physicians said they were unable to spend enough time with each patient. Less than a quarter of physicians in the U.S. reported satisfaction with the amount of time they could dedicate to their patients.
The majority of surveyed physicians in most countries reported spending less than 15 minutes with each patient (Table 2). In the U.S., Switzerland, and Sweden, over half of physicians said they spent more than 15 minutes with their patients. In Sweden, 91 percent of surveyed physicians believed this was still inadequate.
The vast majority of primary care physicians were unhappy with their daily workload, with more than 80 percent of physicians in nine out of the 10 countries reporting not being satisfied. Dissatisfaction was lower in Switzerland, but most physicians — more than seven in 10 — still reported not being satisfied with their daily workload.
More than 90 percent of primary care physicians in every country reported dissatisfaction with spending too much time on administrative work.
Apart from Switzerland, more than two-thirds of primary care physicians in every country said they were dissatisfied with their work–life balance. Only one of five physicians in the U.S. reported being satisfied. Research shows that maintaining a balanced life outside work — including getting proper sleep, nutrition, and exercise, and spending time with family and friends — is important for working efficiently and delivering consistently high-quality care to patients.6
Discussion
Our findings show that primary care physicians in all 10 countries are largely unsatisfied with several aspects of their medical practice. Even among physicians who reported feeling “extremely” or “very” satisfied, more than a third in half the surveyed countries reported the quality of care they were able to provide worsened with the COVID-19 pandemic. Evidence suggests satisfaction rates may vary within countries by practice size and location, with physicians in smaller or group practices being more satisfied than their counterparts in larger practices (sample-size limitations, however, prevented us from disaggregating our analysis).7
Consistent with prior research, results from our survey suggest primary care physicians have limited time to meet with patients and complete administrative tasks. This means they are not able to provide some patient services or deliver them in a way that is gratifying and according to care guidelines — all of which are tied to burnout and poorer patient outcomes.8 Studies have found that some physicians spend as much, if not more, time viewing the electronic health record of a patient as they do actually seeing the patient. While the information contained in electronic health records can facilitate more efficient care, its associated tasks can be cumbersome, at times undermining effective communication and connection in care settings.
Reducing primary care physician workloads — something more than 80 percent of physicians in nearly every country reported struggling with — could increase satisfaction and lower high rates of stress and burnout. A 10 percent decrease in a physician’s workload in the United States has been shown to lower the odds of burnout by one-third.9 Strategies to streamline administrative work and reduce workload — as well as enhance care delivery — include redesigning health care information processing technology with the input of physicians. This could reduce time spent on maintaining electronic health records and other electronic administrative tasks.10
Restructuring reimbursement is another critical tool for improving primary care. Moving toward a value-based payment model, for example, can improve physician workloads by minimizing the need for administrative and billing work after the provision of services.11 By tying physician payment to health outcomes, value-based care also disincentivizes seeing a high volume of patients in favor of a comprehensive approach to patient care.12 Value-based reimbursements also could encourage more physicians to join the primary care workforce and foster an environment that supports career longevity.13
There is an undeniable crisis in primary care around the globe, and the U.S. is no exception. We cannot expect to receive the highest-quality care from physicians who are burned out, demoralized, and dissatisfied with core aspects of their work lives. By understanding how primary care physicians are feeling, particularly since the onset of COVID-19, we can gain insight into what they need in order to deliver high-quality patient care.
How we conducted this survey
See the original publication (this is an excerpt version)
Acknowledgments
See the original publication (this is an excerpt version)
Notes
See the original publication (this is an excerpt version)
About the Authors
Evan D. Gumas – Research Associate, International Health Policy and Practice Innovations, The Commonwealth Fund
Munira Z. Gunja – Senior Researcher, International Program in Health Policy and Practice Innovations, The Commonwealth Fund
Arnav Shah – Senior Research Associate, Policy and Research, The Commonwealth Fund
Reginald D. Williams II – Vice President, International Health Policy and Practice Innovations, The Commonwealth Fund
Originally published at https://www.commonwealthfund.org
