One highly under discussed issue of mashing is related to gelatinization. It's an annual and regional variable in the barley crops. In good years its closer to 140F and you never see an issue. Some really bad crops can actually be above 150F. If you can't get the starch into solution the enzymes can't convert it.
That's why i always advocate taking a gravity sample after about 20 mintues into your first step. If you aren't seeing >85% of your expected first wort gravity already you will need some more heat to release the starches.
There are other potential issues that can cause low efficiency too, but mashing at 146 is a a bit of a red flag. Only way to know is to test. I normally do a hochkurz style mash to reach 100% conversion every time.