According to a new study, doctors who work in clinics that predominantly serve people of color face serious challenges, which can affect their patients’ care.

Between 2001 and 2005, researchers from Loyola University Medical Center in Maywood, Illinois, surveyed more than 95 clinics—of those, 27 had 30 percent or more minority patients. The researchers found that these clinics were four times more likely to report having a chaotic work environment compared with the other clinics environment. They also noted that their patients spoke little or no English, were involved in cases that are medically and psychologically complex and had lower health literacy. In addition, these clinics are also saddled with insufficient access to pharmacy services, fewer patient examination rooms per physician and limited educational materials for patients with hypertension and congestive heart failure.

The study’s authors wrote: “These deficiencies may contribute to physician stress and time pressure, thereby complicating interactions with disproportionately higher percentages of medically and psychosocially complex patients. The combination of time pressure, insufficient resources and complex patients likely constitutes a ‘perfect storm’ that contributes to the challenges that physicians face in providing quality care to large proportions of minority patients.”