Predictors of burnout among physicians and advanced-practice clinicians in central New York

Abstract

Background: Provider wellbeing is a barometer of the strength of healthcare systems/organizations. Burnout prevalence among physicians exceeds that among other adult workers in the United States. Rural-based practitioners might be at greater risk. Objective: We investigated predictors of burnout among group-employed providers within an integrated healthcare network. Methods: In a prospective observational study of physicians/advanced-practice clinicians serving an 8-county region of central New York, we linked administrative practice-setting data with responses to a questionnaire-survey comprising validated measures of burnout, resilience, work meaningfulness, satisfaction, risk aversion, and uncertainty/ambiguity tolerance. We included providers on the official payroll, excepting advisory board and/or research team members plus those who retired, resigned or were fired. 308 (65.1%) of 473 eligible clinicians completed the survey. 59.1% of these were physicians/doctoral-level practitioners; 40.9% advanced-practice clinicians. We assessed burnout using a validated 5-level single-item measure formatted as a binary outcome of "burned out/burning out" (levels 3-5) versus not. We derived a parsimonious generalized linear mixed-effects regression of this outcome on provider demographics, work-related needs, risk aversion, satisfaction, and unit characteristics. Results: Perceived workload, relatedness needs, practice satisfaction ≥ 75% of the time, dissatisfaction ≥ 50%, resilience, and practicing on a small unit were the significant, independent predictors. Conclusions: Heavy workloads, unmet relational needs, frequent dissatisfaction, low resilience, and serving on a small unit were most significantly associated with being "burned out/burning out". Feeling satisfied most of the time and high resilience were protective. Profession, specialty, autonomy, and support staffing were not statistically significant.

The reliability and validity of three‐item screening measures for burnout: Evidence from group‐employed health care practitioners in upstate New York

“…We demonstrated convergent validity of burnout screening measures by testing their correlations with workload and job dissatisfaction. We measured “perceived workload” on a five‐item scale described in a previous report (Waddimba et al, ). Constituent items inquire about patient load, leaving work undone, taking work home, exceeding one's fair share of workload, and neglecting health due to work, on a four‐point Likert‐style response format from 1 (“ Never [0% of the time]”) to 4 (“ Frequently [>75% of the time]”).…”

Resilience among Employed Physicians and Mid‐Level Practitioners in Upstate New York

“…We conducted secondary analysis of cross‐sectional data from the Practitioner Resilience, Adaptability and Wellbeing Study (PRAWS) (Waddimba et al. ,b), a prospective observational study investigating a community of physicians and mid‐level practitioners of patient care within an integrated delivery system.…”

“…We assessed subjective workload quantity by a perceived workload scale specifically designed for the parent study, and described in a previous report (Waddimba et al. ). It comprises five items (e.g., I feel stressed out from having too much work ), each rated on a four‐point Likert‐style response format ranging from 1 = “ Never or 0 percent of the time” to 4 = “ Frequently or >75 percent of the time.” It was scored by summing up the items.…”

Burnout and Job and Career Satisfaction in the Physician Assistant Profession: A Review of the Literature

“…In addition, lower career satisfaction was associated with insuffi cient resources for managing patients with complex clinical conditions [12]. Using cross-sectional data from the Practitioner Resilience, Adaptability and Wellbeing Study [41], Waddimba and colleagues evaluated burnout among rural clinicians in an integrated health care system in New York. Similar to Whitebird et al, researchers found that nearly a third of clinicians reported symptoms of burnout using the single-item PWS measure.…”

“…Similar to Whitebird et al, researchers found that nearly a third of clinicians reported symptoms of burnout using the single-item PWS measure. Risk factors for burnout included employment in smaller clinics, lower tolerance of stress, more frequent dissatisfaction with practice, and unmet relationship needs [41].…”