Healthcare changes lead to an increasingly unhappy workplace in federally qualified health centers

Female nurse looking stressed
Possible stressors for clinicians and staff that have led to unhappy working conditions include the rapid adoption of new EHRs, which can disrupt workflow and distract from face-to-face patient care. (Getty/gpointstudio)

Changes in the healthcare system have the potential to improve or worsen working conditions for clinicians and staff.

Unfortunately, all the changes taking place in federally qualified health centers (FQHCs) have led to increasingly dissatisfied clinicians and staff, according to a study published this week in Health Affairs.

Health system changes—including incentives to adopt electronic health records, exposure to alternative payment models and efforts to encourage practice transformation—have made working conditions worse in a national sample of 296 FQHCs studied by the RAND Corporation.

The study showed declines over time in multiple measures of professional satisfaction, work environment and practice culture. The researchers said their analysis did not allow them to identify the factors that contributed to the decline but worried about the effect of further changes to come.

“As additional health system changes accumulate under the Medicare Access and CHIP Reauthorization Act of 2016 (MACRA) and new legislative and regulatory activity, policy makers should consider further study of how these forces could affect primary care working conditions—especially in FQHCs and other safety-net clinics,” they concluded.

Physician practices are now in the first year of the new payment system put in place by MACRA. A new survey by the Medical Group Management Association found respondents said the most burdensome regulation is MACRA’s Merit-Based Incentive Payment System (MIPS) program, cited by 82% of respondents as “very” or “extremely” burdensome. Medical groups cite clinical relevance to patient care (80%) as their top MIPS concern.

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In the RAND study, researchers found there were no significant improvements on any of the measures it used, suggesting working conditions in FQHCs have deteriorated recently. The researchers said they could not say whether findings would be similar in other primary care practices. While they didn’t identify causes of the decline, the researchers said possible stressors for clinicians and staff include the rapid adoption of new EHRs which can disrupt workflow and distract from face-to-face patient care, expansion of coverage under the Affordable Care Act, which may have caused a surge in patients for many clinics and medical home transformation efforts.

The increasing administrative burden on physicians associated with EHRs has received attention as a factor in physician burnout, leading to questions over whether the technology creates as many safety concerns as it solves.