‘Stretched too thin’ – Primary care physicians too busy to take on additional research

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Large-scale scientific inquiry must go on hold sometimes when primary care physicians and their staff members are running ragged caring for patients.

A new study examined why some Midwestern primary care practices declined to participate in formal, government-led quality improvement (QI) studies to curb unhealthy alcohol use or improve heart health.

The main reason: Short-staffed practices simply can’t take on more work.

“Overwhelmingly, staff turnover and shortages, spanning both physician and support staff roles, were identified as primary reasons for declining, and many noted that staffing challenges were exacerbated during the (COVID-19) pandemic,” the researchers said.

During the pandemic, health care workers left their jobs, taking their institutional knowledge about practice operations and electronic health records (EHRs). Now many practices are “struggling to maintain normal clinical operations,” and QI research has become impossible for some.

Finding investigators

The U.S. Agency for Healthcare Research and Quality (AHRQ) has the EvidenceNOW initiative to test interventions for primary care. Researchers examined four projects, two recruiting physicians to test screenings, interventions and treatments for unhealthy alcohol use, and two focusing on heart health through blood pressure and tobacco use.

All the projects were set in Illinois, Indiana, Michigan, Ohio and Wisconsin, with recruitment periods ranging from February 2020 to May 2022. Time commitments ranged from one to three hours a month, with various levels of staff participation.

The researchers called and emailed to ask why some practices declined to participate. Respondents “often reported that clinicians were ‘stretched too thin’ and simply ‘could not be asked to do one more thing,’” the study said. The researchers found “for many primary care practices, enrollment in new QI projects is simply not feasible under current conditions.”

Other reasons were:

• Physicians felt they already provided good care to patients about unhealthy alcohol use or cardiovascular disease.
• Challenges with EHRs that would not easily report performance data.
• Insufficient compensation, which ranged from nothing to $4,000.

Possible solutions

The respondents struggled to make recommendations that would spur more physician participation. Some minor suggestions were to identify the right contact person at a practice for the recruitment process, explain project benefits for reimbursement, and more pay.

Policy reforms to improve work environments for clinicians, reduce administrative burdens, and support clinician well-being could help. Reducing burnout would allow more clinicians to engage in QI projects, according to the study.

Lawmakers also could expand the primary care workforce with loan repayments or scholarships, such as those offered by the National Health Service Corps.

“There appears to be movement toward these supports,” the study said, noting the U.S. Department of Labor’s $80 million Nursing Expansion Grant Program to expand and diversify the nursing workforce, the study said. Those grants were awarded in spring and in summer, the U.S. Department of Health and Human Services announced a national plan to spend $100 million to grow the nursing workforce across the nation.

The U.S. Centers for Medicare & Medicaid Services could offer QI project incentives. QI project leaders could embed assistants in practices or pay practices for every hour of participation.

QI research is not totally gone from primary care. The researchers said the study may appear “overly pessimistic,” but noted all four AHRQ EvidenceNOW projects were able to recruit practices to study patient outcomes.

“Declining Participation in Primary Care Quality Improvement Research: A Qualitative Study,” was published in Annals of Family Medicine.