Associations Between Burnout and Practice Organization in Family Physicians

Abstract

PURPOSE Burnout has been reported to be as high as 63% among family physicians and has negative effects on physicians, patients, and the medical system. There are likely structural causes of burnout, but little is known about the relationship between practice organization and burnout. Our objective was to study this association in family physicians. METHODS This cross-sectional study uses secondary data supplied by practicing physicians from the 2017 American Board of Family Medicine (ABFM) Family Medicine Certification examination registration questionnaire, a mandatory component of registration, yielding a 100% response rate. Burnout was measured as a positive response to either of 2 validated questions measuring emotional exhaustion and depersonalization. Practice environment was measured with questions on work stressors and teamwork. Logistic regression determined independent associations between burnout and individual and practice characteristics. RESULTS Of the 1,437 physicians included, the burnout rate was 43.7%; 33.7% worked in hospital-owned practices and 65.5% reported no ownership stake in their practice. Controlling for personal characteristics and practice organization, being in a hospital-owned practice (odds ratio (OR) = 1.68; 95% CI, 1.14-2.46) and being a partial owner (OR =1.67; 95% CI, 1.13-2.46) were positively associated with burnout. When also controlling for practice environment, no practice organization variable remained associated with burnout. CONCLUSION Burnout in family physicians should not be attributed solely to practice organization. No single practice type or ownership status was independently associated with burnout, which indicates that any practice can attempt to mitigate burnout.

Family Physician Burnout Does Not Differ With Rurality

“…Additionally, one-third of rural physicians in our survey (33.3%) reported being a faculty member. Consistent with previous findings, 20 our data suggest that FPs tend to be primarily employed in hospital-owned practices (40.9% of rural FPs and 32.9% of urban FPs) followed by group private practice (20.8% of rural FPs and 23.7% of urban FPs). In our study, we found no significant difference in burnout between rural (45.1%) and urban (43.0%) FPs.…”

“…We found small differences in burnout by practice organization and percent vulnerable population, but no difference by scope of practice or rural location. Consistent with past work, 20,21 FPs in practice environments with lack of control over workload, less time for documentation, and more chaos and stress were more likely to report burnout.…”

Academic Achievement, Professionalism, and Burnout in Family Medicine Residents

“…We assessed burnout using two items that correspond to the emotional exhaustion and depersonalization scales of the Maslach Burnout Inventory. 24 Following past work, [25][26][27] we defined burnout as responses to either the emotional exhaustion or depersonalization items at "once a week or more" or more frequently. We characterized whether the resident was meeting expectations on the professionalism milestones at each evaluation starting with a 4 at the end of year PGY-3 rating and removing 0.5 points for each of the preceding ratings.…”

Burnout

“…But here again, there is little research to support a causal relationship with burnout. 8 In the absence of clear and convincing proof, we are left to imagine why burnout is such a burning issue. We are left with our own experiences; we are left with what we choose to believe.…”