Depression, time pressure negatively affect physicians' ability and well-being, studies find

Two recent studies looked at current challenges facing physicians and how they affect their ability to practice.

The first, a systematic review and meta-analysis of 11 studies involving 21,517 physicians, found that those with a positive screening for depression were highly likely to report medical errors. Results were published Nov. 27 by JAMA Network Open.

The overall relative risk (RR) for medical errors among physicians with depression was 1.95 (95% CI, 1.63 to 2.33) (P<0.001), with high heterogeneity across the studies, most of which was explained by study design. There was less association between depression and medical errors in the four longitudinal studies (RR, 1.62 [95% CI, 1.43 to 1.84];P=0.33) and more in the seven cross-sectional studies (RR, 2.51 [95% CI, 2.20 to 2.83]; P=0.14). The meta-analysis of four longitudinal studies (involving 4,462 individuals) found that medical errors associated with depressive symptoms had a pooled RR of 1.67 (95% CI, 1.48 to 1.87) (P=0.60), suggesting that the association between physician depressive symptoms and medical errors is bidirectional, the study noted.

Further research is needed to evaluate whether interventions to reduce physician depressive symptoms could reduce medical errors, according to the study authors.

“We also found that the magnitude of the associations of physician depressive symptoms and perceived medical errors were relatively consistent across studies that assessed training and practicing physicians, providing additional evidence that physician depression has implications for the quality of care delivered by physicians at different career stages,” they wrote.

The second study used the Healthy Work Place randomized trial of 168 physicians and advanced practice clinicians in 34 primary care practices in the Upper Midwest and East Coast of the United States to assess the relationship among work-life factors, clinician outcomes, and time pressure during office visits.

Time pressure was defined as clinicians needing more time than allotted to provide quality care. Other metrics included work control, work pace (calm to chaotic), organizational culture and clinician satisfaction, stress, burnout, and intent to leave the practice. Results were published Dec. 3 by the Journal of General Internal Medicine.

Sixty-seven percent of clinicians needed more time for new patients, and 53% needed additional time for follow-up appointments. Time pressure in new-patient visits occurred more often among general internists than family physicians (74% vs. 55%; P<0.05), among female clinicians than male (78% vs. 55%; P<0.01), and among clinicians with larger numbers of patients with complex psychosocial needs (81% vs. 59%; P<0.01) or limited English proficiency (95% vs. 57%; P<0.001).

Time pressure in new-patient visits was associated with lack of control, clinician stress, and intent to leave practice (small to moderate effect sizes, P<0.05), while time pressure in follow-up visits was associated with chaotic workplaces and burnout (small to moderate effect sizes, P<0.05). Time pressure improved over time in workplaces with values alignment and an emphasis on quality, the study found.

“Although time pressure in primary care is not new, it is troubling that despite numerous articles describing it, the prevalence of physicians experiencing time pressure continues to rise,” the authors wrote. “Thus the primary care workplace, described as feeling like a ‘hamster on a wheel,’ has continued to generate time pressure, which makes even more clinicians feel unable to complete their work.” The authors called for future studies evaluating these findings in larger samples with more geographic diversity.