Family Physician Burnout Does Not Differ With Rurality

Abstract

Burnout affects about half of family physicians (FPs). Minimal research exists which examines the impact of urban and rural practice settings on FP burnout. In this study, we examined whether rural practice is associated with FP burnout.Methods: Data from the 2017 and 2018 American Board of Family Medicine Family Medicine Certification examination registration questionnaire were used. We limited our sample to FPs in continuity care in the United States. The questionnaire is a mandatory component of registration, resulting in a 100% response rate. Burnout was measured via 2 questions validated against the Maslach Burnout Inventory. We used logistic regression to determine associations between burnout and rural location, controlling for practice and personal characteristics.Findings: Of the FPs surveyed, 2,740 met our inclusion criteria. Rural FPs were older, more likely to be male, and had a broader scope of practice than urban FPs. Rural FPs had a nonsignificantly higher burnout rate than urban FPs (45.1% vs 43.0%). Burnout was more common in younger and female FPs. We found no rural/urban differences between job satisfaction, practice environment, workload, and job stress; however, all of these characteristics were associated with burnout. In adjusted analyses, rural location was not associated with burnout (odds ratio = 1.15, 95% CI: 0.87-1.52). Conclusion:In a large national sample, we found no difference in burnout between rural and urban FPs. This suggests there is nothing unique about rural practice that predisposes to burnout and that a common pathway to reduce burnout may exist.

Effects of the scope of practice on family physicians: a systematic review

“…In total, we included 12 studies with 38,732 participants from 6927 citations identified from literature search strategies (see Fig. 1) [20][21][22][23][24][25][26][27][28][29][30][31]. Among these included studies, eleven were cross-sectional studies [20][21][22][23][24][26][27][28][29][30][31], and one was a cohort study [25].…”

“…1) [20][21][22][23][24][25][26][27][28][29][30][31]. Among these included studies, eleven were cross-sectional studies [20][21][22][23][24][26][27][28][29][30][31], and one was a cohort study [25]. The included studies were published between 1996 [27] and 2020 [30,31] and were conducted in the USA (N = 6) [21-23, 27, 28, 31], in Canada (N = 4) [20,24,26,29], in Portugal (N = 1) [25], and in Switzerland (N = 1) [30].…”

“…The mean age of the participants was reported in seven studies and varied from 35.9 [28] to 55.0 [22] (median = 53.1). Gender information was reported in 11 studies [20][21][22][23][24][25][26][28][29][30][31] with the percentage of women varying from 0.11 [29] to 0.59 [28] (median = 0.44). The clinical experience in years was rarely reported in the included studies, except for three studies in which this information was reported differently: a mean age of 16.3 [20], a median age of 22.0, [20] and a percentage, i.e., a total of 41.0% of participants had at least 21 years of experience in practice [20].…”

“…Table 1 shows a description of the scope of practice as reported in the included studies. The definition of the scope of practice was explicitly reported in six studies [22-25, 28, 31], and covered the dimensions of scope, such as clinical procedures [22][23][24]28], clinical practices [25,28,31], clinical and nonclinical activities [24,30], and practice settings [25,28]. It was self-reported in nine studies [20, 21, 23-26, 28, 30, 31], or reported with objective measures (e.g., direct observation or administrative database) in two studies [22,27], with a mixed approach (subjective and objective measures) used in one study [29].…”

“…After the data analysis, we classified in a posteriori the scope of practice into four categories, including the variety of clinical practices, the diversity of clinical procedures, the diversity of family physician activities (clinical and nonclinical), and the variety of practice settings. Therefore, we found that the scope of practice was characterized by the variety of clinical practices in four studies [23,28,29,31], the diversity of clinical procedures performed in three studies [20][21][22], the diversity of family physician activities (e.g., primary care practices plus clinical teaching) in four studies [24,26,27,30], and the variety of practice settings in which family physicians worked (e.g., hospital plus primary care center versus primary care center) in one study [25].…”