Does Clinic Chaos Lead To Poorer Care For The Poor?

Clinic chaos and poor care

A study published in the Archives of Internal Medicine looked at the influence of workplace conditions on the health care given to patients. The study compared 96 primary care clinics in New York, NY and in the upper Midwest. They wanted to know if the workplace and it's conditions changed the care given to those served.

It used data collected from the MEMO (Minimizing Error, Maximizing Outcome) study. This 4-year (2001-2005) study included information from patients, physicians, and clinic managers assessing how health care workplace factors affect the quality of medical care.

Physicians in both types of clinics had similar workweeks. Those who worked in clinics with larger minority populations saw fewer patients per month and reported fewer days on call per month than physicians in clinics with fewer minority patients.

Doctors working in clinics with at least 30% minority patients had problems with access to medical supplies and educational materials for patients. They also had difficulty getting patients to specialists when needed. They had more trouble getting an interpreter when needed making communication with patients difficult at times.


These clinics had fewer patient exam rooms per physician which tended to longer patient waits in examination rooms.

There did not seems to be any difference in the two groups when it came to follow-up appointments, electronic medical records, patient registration and check-in, insurance approval, or new patient appointment.

The doctors who served the clinics with larger percentages of minority patients reported more clinic chaos. This real or perceived chaos can lead to workplace dissatisfaction and "burn-out" on the part of the staff. This can lead to increased staff turnover.

The authors of the study write "Significant workplace organizational differences were found between clinics that serve high proportions of minority patients and those that do not. Further study is needed to examine the effects of work environment and physician factors on quality of care."

The question remains "Does Clinic Chaos Lead to Poorer Care for the Poor?" The answer seems to be "possibly, but it is not settled."

Separate and Unequal: Clinics Where Minority and Nonminority Patients Receive Primary Care; Arch Intern Med. 2009;169(3):243-250; Anita B. Varkey, MD; Linda Baier Manwell, MS; Eric S. Williams, PhD; Said A. Ibrahim, MD, MPH; Roger L. Brown, PhD; James A. Bobula, PhD; Barbara A. Horner-Ibler, MD, MASW; Mark D. Schwartz, MD; Thomas R. Konrad, PhD; Jacqueline C. Wiltshire, PhD; Mark Linzer, MD; for the MEMO Investigators