Time Pressure During Primary Care Office Visits: a Prospective Evaluation of Data from the Healthy Work Place Study

  • Kriti Prasad
  • Sara Poplau
  • Roger Brown
  • Steven Yale
  • Ellie Grossman
  • Anita B. Varkey
  • Eric Williams
  • Hannah Neprash
  • Mark LinzerEmail author
  • for the Healthy Work Place (HWP) Investigators
Original Research



The relationship between worklife factors, clinician outcomes, and time pressure during office visits is unclear.


To quantify associations between time pressure, workplace characteristics ,and clinician outcomes.


Prospective analysis of data from the Healthy Work Place randomized trial.


168 physicians and advanced practice clinicians in 34 primary care practices in Upper Midwest and East Coast.

Main Measures and Methods

Time pressure was present when clinicians needed 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. Hierarchical analysis assessed relationships between time pressure, organizational characteristics, and clinician outcomes. Adjusted differences between clinicians with and without time pressure were expressed as effect sizes (ESs).

Key Results

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 was more prevalent in general internists than in family physicians (74% vs 55%, p < 0.05), women versus men (78% vs 55%, p < 0.01), and clinicians with larger numbers of complex psychosocial (81% vs 59%, p < 0.01) and Limited English Proficiency patients (95% vs 57%, p < 0.001). Time pressure in new patient visits was associated with lack of control, clinician stress, and intent to leave (ESs small to moderate, p < 0.05). Time pressure in follow-up visits was associated with chaotic workplaces and burnout (small to moderate ESs, p’s < 0.05). Time pressure improved over time in workplaces with values alignment and an emphasis on quality.


Time pressure, more common in women and general internists, was related to chaos, control and culture, and stress, burnout, and intent to leave. Future studies should evaluate these findings in larger and more geographically diverse samples.


time pressure physician satisfaction health services research medical culture primary care workforce 



HWP Investigators include those listed in the author group and Diane Kohnhorst, Marshfield Clinic, Marshfield WI; Jill Wallock, Loyola University School of Medicine, Chicago, IL; Michael Barbouche, Forward Health Group, Madison, WI; and Dr. Lanis Hicks, University of Missouri, Columbia, MO. Ms. Kohnhorst and Ms. Wallock were involved in data collection, Mr. Barbouche in study design, and Dr. Hicks in study design and data interpretation.

Funding Information

This study is supported the Agency for Healthcare Research and Quality (AHRQ) Grant No. 5R18-HS018160-03.

Compliance with Ethical Standards

Site-specific Institutional Review Boards provided approval.

Conflict of Interest

Mark Linzer and Sara Poplau acknowledge support by the American Medical Association and the American College of Physicians for worklife training and oversight of ongoing projects. Dr. Linzer is supported by the Institute for Healthcare Improvement for his role in the Joy in Work initiative. All other authors declare that they have no conflicts of interest.

Healthy Workplace Investigators: Dr. Hicks receives royalties from a textbook; Mr. Barbouche is the Founder and CEO of a healthcare data management company in Madison, WI, Forward Health Group, and owns stock in the company.

Supplementary material

11606_2019_5343_MOESM1_ESM.docx (22 kb)
ESM 1 (DOCX 21.9 KB).


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Copyright information

© Society of General Internal Medicine 2019

Authors and Affiliations

  • Kriti Prasad
    • 1
    • 2
    • 3
  • Sara Poplau
    • 1
    • 2
    • 3
  • Roger Brown
    • 4
  • Steven Yale
    • 5
  • Ellie Grossman
    • 6
  • Anita B. Varkey
    • 7
  • Eric Williams
    • 8
  • Hannah Neprash
    • 9
  • Mark Linzer
    • 1
    • 2
    • 3
    • 10
    Email author
  • for the Healthy Work Place (HWP) Investigators
  1. 1.Division of General Internal MedicineHennepin HealthcareMinneapolisUSA
  2. 2.Office of Professional WorklifeHennepin HealthcareMinneapolisUSA
  3. 3.Hennepin Healthcare Research InstituteHennepin HealthcareMinneapolisUSA
  4. 4.School of NursingUW-MadisonMadisonUSA
  5. 5.University of Central Florida College of MedicineOrlandoUSA
  6. 6.Cambridge Health AllianceCambridgeUSA
  7. 7.Loyola University Stritch School of MedicineMaywoodUSA
  8. 8.University of AlabamaTuscaloosaUSA
  9. 9.University of Minnesota School of Public HealthMinneapolisUSA
  10. 10.Department of Medicine Hennepin HealthcareMinneapolisUSA

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