ArticleBMC health services research2009
High workload and job stress are associated with lower practice performance in general practice: an observational study in 239 general practices in the Netherlands.
Article in BMC health services research, 2009. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 53 papers, 3 of them syntheses that pooled it.
What it found
Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.
The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.
Who cites it
53 citing papers in PubMed, 3 syntheses or guidelines pooled it, 128 citations in OpenAlex.
- Direct Access for Patients to Diagnostic Testing and Results Using eHealth: Systematic Review on eHealth and Diagnostics.Journal of medical Internet research · 2022Pooled it
- Association Between Physician Burnout and Patient Safety, Professionalism, and Patient Satisfaction: A Systematic Review and Meta-analysis.JAMA internal medicine · 2018Pooled it
- A Systematic Review of the Impact of Physicians' Occupational Well-Being on the Quality of Patient Care.International journal of behavioral medicine · 2015Pooled it
- Trial
- Trial
- "There is never any rest, never enough time and too much to do": a qualitative study of GP work intensity in an Irish context.BMC primary care · 2026Article
- Changes in working hours and burnout levels among physicians: a cohort study.Human resources for health · 2026Article
- Evaluation of two easy-to-implement digital breathing interventions in the context of daily stress levels in a series of N-of-1 trials: results from the Anti-Stress Intervention Among Physicians (ASIP) study.NPJ digital medicine · 2026Article
- Work-related stress and its associated factors among primary care doctors in Malaysia during the COVID-19 pandemic.BMC primary care · 2025Article
- Leaders' Perspectives on Resources for Academic Success: Defining Clinical Effort, Academic Time, and Faculty Support.The Permanente journal · 2024Article
- Impact of primary care physicians working part-time on patient care: A scoping review.The European journal of general practice · 2023Article
- What can we learn from experiences in general practice during the COVID-19 pandemic? A qualitative study.BMC health services research · 2023Article
- Determinants of referral for suspected coronary artery disease: a qualitative study based on decision thresholds.BMC primary care · 2023Article
- Cognitive mechanisms and resilience in UK-based general practitioners: cross-sectional findings.Occupational medicine (Oxford, England) · 2023Article
- The Impact of Canadian Medical Delays and Preventive Measures on Breast Cancer Experience: A Silent Battle Masked by the COVID-19 Pandemic.The Canadian journal of nursing research = Revue canadienne de recherche en sciences infirmieres · 2023Article
- The voice of the self: a typology of general practitioners' emotional responses to situational and contextual stressors.Scandinavian journal of primary health care · 2022Article
- Identifying how GPs spend their time and the obstacles they face: a mixed-methods study.The British journal of general practice : the journal of the Royal College of General Practitioners · 2022Article
- The Association Between Patient Safety Culture and Accreditation at Primary Care Centers in Kuwait: A Country-Wide Multi-Method Study.Risk management and healthcare policy · 2022Article
- Workers' Stress During the First Lockdown: Consequences on Job Performance Analyzed With a Mediation Model.Journal of occupational and environmental medicine · 2021Article
- Identifying patients who could benefit from palliative care by making use of the general practice information system: the Surprise Question versus the SPICT.Family practice · 2020Article
Corrections and comments
PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.
Authors and funding
7 authors at 3 institutions in 3 countries.
Funding
No grant is acknowledged in the PubMed record.
Abstract
backgroundThe impact of high physician workload and job stress on quality and outcomes of healthcare delivery is not clear. Our study explored whether high workload and job stress were associated with lower performance in general practices in the Netherlands.
methodsSecondary analysis of data from 239 general practices, collected in practice visits between 2003 to 2006 in the Netherlands using a comprehensive set of measures of practice management. Data were collected by a practice visitor, a trained non-physician observer using patients questionnaires, doctors and staff. For this study we selected five measures of practice performance as outcomes and six measures of GP workload and job stress as predictors. A total of 79 indicators were used out of the 303 available indicators. Random coefficient regression models were applied to examine associations. RESULTS AND DISCUSSION: Workload and job stress are associated with practice performance.Workload: Working more hours as a GP was associated with more positive patient experiences of accessibility and availability (b = 0.16). After list size adjustment, practices with more GP-time per patient scored higher on GP care (b = 0.45). When GPs provided more than 20 hours per week per 1000 patients, patients scored over 80% on the Europep questionnaire for quality of GP care.Job stress: High GP job stress was associated with lower accessibility and availability (b = 0.21) and insufficient practice management (b = 0.25). Higher GP commitment and more satisfaction with the job was associated with more prevention and disease management (b = 0.35).
conclusionProviding more time in the practice, and more time per patient and experiencing less job stress are all associated with perceptions by patients of better care and better practice performance. Workload and job stress should be assessed by using list size adjusted data in order to realise better quality of care. Organisational development using this kind of data feedback could benefit both patients and GP.
Indexed as
Identifiers
What OpenQuestion holds
Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.