Article Figures & Data
Tables
- Table 1
Clinical Practice Areas and Procedures Captured in the 2016 National Family Medicine Graduate Survey (N = 1,617)
No. (%) practicing Clinical practice areas Pediatric outpatient care 1,386 (85.7) Newborn hospital care 452 (28.0) Pediatric hospital care (not newborn) 343 (21.2) Maternity care 442 (27.3) Intensive care/ICU-CCU 263 (16.3) End-of-life care 1,035 (64.0) Behavioral health care 1,491 (92.2) Integrative health care (eg, acupuncture, massage therapy, etc) 332 (20.5) Clinical procedures Women’s health Endometrial biopsy 490 (30.3) IUD insertion and removal 771 (47.7) Implantable long-acting reversible contraception (eg, nexplanon) 369 (39.5) Colposcopy 284 (17.6) Uterine aspiration/D & C (n = 1,609) 84 (5.2) Pregnancy termination (n = 1,605) 44 (2.7) Basic obstetrics ultrasound (AFI, fetal presentation, placental location) 258 (15.9) Orthopedics/musculoskeletal medicine Casting 467 (28.9) Joint aspiration and injection 1,300 (80.4) Musculoskeletal ultrasound 127 (7.9) Genitourinary Vasectomy 84 (5.2) Neonatal circumcision 357 (22.1) Miscellaneous Cardiac stress testing 147 (9.2) Osteopathic manipulative treatment 186 (11.5) Buprenorphine treatment 119 (7.4) Management of HIV/AIDS 304 (18.9) Management of hepatitis C 392 (24.2) ICU-CCU = intensive care unit-critical care unit; IUD = intrauterine device; D & C = dilatation and curretage; AFI = amniotic fluid index.
- Table 2
Personal and Scope of Practice Characteristics of 2013 Family Medicine Residency Graduates Who Practice Continuity of Care (N = 1,617)
Characteristic No. (%) or Mean (SD) Burned out 677 (41.9) Female 948 (58.6) MD degree [vs DO degree] 1369 (84.7) US medical graduate [vs international medical graduate] 1,081 (66.8) Age in years, mean (SD) 35.9 (4.4) Patient encounters per day, mean (SD) 20.3 (6.8) Takes after-hours call 1,199 (74.2) See patients weekends and/or evenings 844 (52.2) In addition to principal practice site, routinely see patients at: Another outpatient clinic 183 (11.3) Urgent care clinic 214 (13.2) Emergency department 111 (6.9) Hospital (not emergency department) 459 (28.4) Nursing home or assisted living facility 227 (14.0) Hospice facility 38 (2.4) Other institutional setting (school-based clinic, correctional facility) 48 (3.0) Patient homes 41 (2.5) Other 60 (3.7) Number of additional patient care settingsa 0 747 (46.2) 1 528 (32.7) 2 214 (13.2) 3 or more 128 (7.9) Number of procedures/content areas in current practice, mean (SD) 7.7 (4.6) Practice adult inpatient medicine 605 (37.4) Currently delivering babies 249 (15.4) DO = Doctor of Osteopathy; MD = Doctor of Medicine.
↵a Confidence interval of 98.75% for each individual level of patient care setting sum using Bonferonni adjustment.
- Table 3
Bivariate Associations Between Burnout and Physician Characteristics and Scope of Practice of 2013 Family Medicine Residency Graduates Who Practice Continuity of Care (N = 1,617)
Characteristic Burned Outa (n = 677) No. (%) or Mean (SD) Not Burned Out (n = 940) No. (%) or Mean (SD) P Value Sex Male 252 (37.2) 417 (44.4) .004b Female 425 (62.8) 523 (55.6) Degree MD degree 568 (83.9) 801 (85.2) .47 DO degree 109 (16.1) 139 (14.8) Medical school location International medical graduate 202 (29.8) 334 (35.5) .016b US medical graduate 475 (70.2) 606 (64.5) Age 35.7 (4.2) 36.0 (4.6) .12 Patient encounters per day 20.2 (6.5) 20.3 (7.1) .76 Takes after-hours call 502 (74.2) 697 (74.2) .99 See patients weekends/evenings 362 (53.5) 482 (51.3) .38 In addition to principal practice site, routinely see patients at: Another outpatient clinic 68 (10.0) 115 (12.2) .17 Urgent care clinic 82 (12.1) 132 (14.0) .26 Emergency department 40 (5.9) 71 (7.6) .20 Hospital (not emergency) 164 (24.2) 295 (31.4) .0016b Nursing home or assisted living facility 84 (12.4) 143 (15.2) .11 Hospice facility 13 (1.9) 25 (2.7) .33 Other institutional setting (school-based clinic, correctional facility) 22 (3.3) 26 (2.8) .57 Patient homes 10 (1.5) 31 (3.3) .02b Other 20 (3.0) 40 (4.3) .17 Number of additional settings .001b 0 349 (51.6) 398 (42.3) n/a 1 210 (31.0) 318 (33.8) n/a 2 71 (10.5) 143 (15.2) n/a 3 or more 47 (6.9) 81 (8.6) n/a Number of procedures/clinical areas part of current practice 7.02 (4.0) 7.49 (4.1) .02b Practice adult inpatient medicine 212 (31.3) 393 (41.8) <.0001b Currently delivering babies 80 (11.8) 169 (18.0) .0007b - Table 4
Adjusted Associations Between Personal and Scope of Practice Characteristics With Burnout Among 2013 Family Medicine Residency Graduates Who Practice Continuity of Care (N = 1,617)
Characteristic OR (95% CI) P Value Female (ref = male) 1.32 (1.07–1.62) .009a DO degree (ref = MD degree) 0.93 (0.70–1.25) .65 US medical graduate (ref = international medical graduate) 1.37 (1.08–1.75) .0099a Age 0.99 (0.97–1.01) .40 Per one additional patient encounter per day 1.00 (0.99–1.02) .91 Take after-hours call 1.04 (0.82–1.31) .77 See patients weekends and/or evenings 1.20 (0.98–1.47) .083 Practice inpatient medicine 0.70 (0.56–0.87) .0017a Practice obstetrics 0.64 (0.47–0.88) .0058a Practice pediatric ambulatory care 0.88 (0.66–1.19) .42 DO = Doctor of Osteopathy; MD = Doctor of Medicine.
↵a P value <.05.
Additional Files
The Article in Brief
Burnout and Scope of Practice in New Family Physicians
Lars E. Peterson , and colleagues
Background Family physicians report some of the highest levels of burnout. This study examines associations between family physician scope of practice and self-reported burnout.
What This Study Found Early career family physicians who provide a broader scope of practice report significantly lower rates of burnout. The study--a secondary analysis of the 2016 National Family Medicine Graduate Survey--found that those who practiced in more locations and performed a greater variety of procedures and clinical work were significantly less likely to report feeling burned out once a week or more. The strongest associations were in the practice of obstetrics and inpatient medicine, two areas with a decline in practice by family physicians in recent years. Specifically, the odds of reporting feeling burned out were 36 percent lower among those family physicians practicing obstetrics and 30 percent lower among those practicing inpatient medicine compared to their peers. Making house calls was also significantly associated with lower burnout.
Implications
- If future research confirms a causal relationship between scope of practice and physician wellness, the authors suggest, it would allow for new policy levers and incentives for systems and physicians to improve health care as well as their own health.
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