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Research ArticleOriginal Research

Burnout and Scope of Practice in New Family Physicians

Amanda K. H. Weidner, Robert L. Phillips, Bo Fang and Lars E. Peterson
The Annals of Family Medicine May 2018, 16 (3) 200-205; DOI: https://doi.org/10.1370/afm.2221
Amanda K. H. Weidner
1Family Medicine Residency Network, Department of Family Medicine, University of Washington, Seattle, Washington
MPH
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Robert L. Phillips Jr
2American Board of Family Medicine, Lexington, Kentucky
MD, MSPH
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Bo Fang
2American Board of Family Medicine, Lexington, Kentucky
PhD
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Lars E. Peterson
2American Board of Family Medicine, Lexington, Kentucky
MD, PhD
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Article Figures & Data

Tables

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    • View popup
    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 care1,386 (85.7)
    Newborn hospital care452 (28.0)
    Pediatric hospital care (not newborn)343 (21.2)
    Maternity care442 (27.3)
    Intensive care/ICU-CCU263 (16.3)
    End-of-life care1,035 (64.0)
    Behavioral health care1,491 (92.2)
    Integrative health care (eg, acupuncture, massage therapy, etc)332 (20.5)
    Clinical procedures
    Women’s health
     Endometrial biopsy490 (30.3)
     IUD insertion and removal771 (47.7)
     Implantable long-acting reversible contraception (eg, nexplanon)369 (39.5)
     Colposcopy284 (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
     Casting467 (28.9)
     Joint aspiration and injection1,300 (80.4)
     Musculoskeletal ultrasound127 (7.9)
    Genitourinary
     Vasectomy84 (5.2)
     Neonatal circumcision357 (22.1)
    Miscellaneous
     Cardiac stress testing147 (9.2)
     Osteopathic manipulative treatment186 (11.5)
     Buprenorphine treatment119 (7.4)
     Management of HIV/AIDS304 (18.9)
     Management of hepatitis C392 (24.2)
    • ICU-CCU = intensive care unit-critical care unit; IUD = intrauterine device; D & C = dilatation and curretage; AFI = amniotic fluid index.

    • View popup
    Table 2

    Personal and Scope of Practice Characteristics of 2013 Family Medicine Residency Graduates Who Practice Continuity of Care (N = 1,617)

    CharacteristicNo. (%) or Mean (SD)
    Burned out677 (41.9)
    Female948 (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 call1,199 (74.2)
    See patients weekends and/or evenings844 (52.2)
    In addition to principal practice site, routinely see patients at:
     Another outpatient clinic183 (11.3)
     Urgent care clinic214 (13.2)
     Emergency department111 (6.9)
     Hospital (not emergency department)459 (28.4)
     Nursing home or assisted living facility227 (14.0)
     Hospice facility38 (2.4)
     Other institutional setting (school-based clinic, correctional facility)48 (3.0)
     Patient homes41 (2.5)
     Other60 (3.7)
    Number of additional patient care settingsa
     0747 (46.2)
     1528 (32.7)
     2214 (13.2)
     3 or more128 (7.9)
    Number of procedures/content areas in current practice, mean (SD)7.7 (4.6)
    Practice adult inpatient medicine605 (37.4)
    Currently delivering babies249 (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.

    • View popup
    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)

    CharacteristicBurned Outa (n = 677) No. (%) or Mean (SD)Not Burned Out (n = 940) No. (%) or Mean (SD)P Value
    Sex
     Male252 (37.2)417 (44.4).004b
     Female425 (62.8)523 (55.6)
    Degree
     MD degree568 (83.9)801 (85.2).47
     DO degree109 (16.1)139 (14.8)
    Medical school location
     International medical graduate202 (29.8)334 (35.5).016b
     US medical graduate475 (70.2)606 (64.5)
    Age35.7 (4.2)36.0 (4.6).12
    Patient encounters per day20.2 (6.5)20.3 (7.1).76
    Takes after-hours call502 (74.2)697 (74.2).99
    See patients weekends/evenings362 (53.5)482 (51.3).38
    In addition to principal practice site, routinely see patients at:
     Another outpatient clinic68 (10.0)115 (12.2).17
     Urgent care clinic82 (12.1)132 (14.0).26
     Emergency department40 (5.9)71 (7.6).20
     Hospital (not emergency)164 (24.2)295 (31.4).0016b
     Nursing home or assisted living facility84 (12.4)143 (15.2).11
     Hospice facility13 (1.9)25 (2.7).33
     Other institutional setting (school-based clinic, correctional facility)22 (3.3)26 (2.8).57
     Patient homes10 (1.5)31 (3.3).02b
     Other20 (3.0)40 (4.3).17
    Number of additional settings.001b
     0349 (51.6)398 (42.3)n/a
     1210 (31.0)318 (33.8)n/a
     271 (10.5)143 (15.2)n/a
     3 or more47 (6.9)81 (8.6)n/a
    Number of procedures/clinical areas part of current practice7.02 (4.0)7.49 (4.1).02b
    Practice adult inpatient medicine212 (31.3)393 (41.8)<.0001b
    Currently delivering babies80 (11.8)169 (18.0).0007b
    • DO = Doctor of Osteopathy; MD = Doctor of Medicine.

    • ↵a Respondents reporting that they feel burned out from my work once a week or more often.

    • ↵b P value <.05.

    • View popup
    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)

    CharacteristicOR (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
    Age0.99 (0.97–1.01).40
    Per one additional patient encounter per day1.00 (0.99–1.02).91
    Take after-hours call1.04 (0.82–1.31).77
    See patients weekends and/or evenings1.20 (0.98–1.47).083
    Practice inpatient medicine0.70 (0.56–0.87).0017a
    Practice obstetrics0.64 (0.47–0.88).0058a
    Practice pediatric ambulatory care0.88 (0.66–1.19).42
    • DO = Doctor of Osteopathy; MD = Doctor of Medicine.

    • ↵a P value <.05.

Additional Files

  • Tables
  • 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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The Annals of Family Medicine: 16 (3)
The Annals of Family Medicine: 16 (3)
Vol. 16, Issue 3
May/June 2018
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Burnout and Scope of Practice in New Family Physicians
Amanda K. H. Weidner, Robert L. Phillips, Bo Fang, Lars E. Peterson
The Annals of Family Medicine May 2018, 16 (3) 200-205; DOI: 10.1370/afm.2221

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Burnout and Scope of Practice in New Family Physicians
Amanda K. H. Weidner, Robert L. Phillips, Bo Fang, Lars E. Peterson
The Annals of Family Medicine May 2018, 16 (3) 200-205; DOI: 10.1370/afm.2221
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  • Variation in Scope and Area of Practice by Family Physician Race and Ethnicity
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  • Practice Organization Characteristics Related to Job Satisfaction Among General Practitioners in 11 Countries
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