Article Figures & Data
Tables
Characteristic Participants
(N = 29 Clinicians)Recruitment Pool
(N = 134 Clinicians)Practice setting Public system Clinics, No. 11 15 Clinicians, No. (%) 20 (69) 88 (66) University system Clinics, No. 5 5 Clinicians, No. (%) 9 (31) 46 (34) Profession type, No. (%) Physician 22 (76) 93 (69) Nurse practitioner 6 (21) 38 (28) Physician assistant 1 (3) 3 (2) Specialty, No. (%) Family medicine 13 (45) 59 (44) Internal medicine 10 (34) 52 (39) Pediatrics 6 (21) 23 (17) Time in clinical practice, No. (%) NA <1 year 1 (3) 1-5 years 11 (38) >5 years 17 (59) Half-day patient care sessions worked per week, mean (range) 4.8 (2-8) NA Minutes per visit, mean (range) 23 (12-30) NA Patients in panel, mean (range) 680 (100-1,600) NA Clinic SDH score, No.a NA 1 0 2 1 3 0 4 2 5 3 6 3 7 10 8 3 9 4 10 2 Burnout riskb NA EE score, No. (%) Low 6 (21) Average 11 (39) High 11 (39) DP score, No. (%) Low 19 (68) Average 6 (21) High 3 (11) EE = emotional exhaustion; DP = depersonalization; NA = data not available; SDH = social determinants of health.
↵a Availability of resources to address social needs. Assessed from response to, “My clinic has the resources, such as dedicated staff, community programs, resources or tools to address patients’ social needs,” on a scale of 1 to 10 where higher score indicates greater agreement.
↵b Among 28 clinicians (1 clinician did not provide responses). EE: 0-1 for low, 2-3 for average, 4-6 for high (range, 1-6). DP: 0-1 for low, 2-3 for average, 4-6 for high (range, 0-5). Response options: 0 = never, 1 = a few times a year or less, 2 = once a month or less, 3 = a few times a month, 4 = once a week, 5 = a few times a week, 6 = every day.36
- Table 2
Illustrative Quotes on How Resources for Social Needs Affect Clinician Efficacy, by Clinicians’ Burnout Risk (N = 28)
DP Score Low to Average EE Score High EE Score Low to average 17 clinicians (SDH score: mean = 6.9; range, 4-10)
“We have a social worker, a care support team. I’m often asking people to make phone calls for me. I feel pretty certain that they can do it. So, I feel good about the care that we provide.” (physician; average EE, low DP; SDH score = 10)
“I feel like [patients] have some responsibility in their own health care. I can give them all the options in the world, if they want to talk to a counselor or they want to go to a group. But if they don’t want to do any of the above, it’s not going to impact my ability to feel like whether I’ve succeeded or not.” (nurse practitioner; average EE, low DP; SDH score = 8)8 clinicians (SDH score: mean = 5.9; range, 2-9)
“A lot of times there are things that you cannot help [patients] with. Some of our patients already are homeless. We are lucky enough to have a social worker, but what can she do? I mean, regular people can’t even afford to live in San Francisco.” (physician; high EE, low DP; SDH score = 5)
“Even if there is a behavioral health navigator, really, it all kind of falls on you.” (physician; high EE, average DP; SDH score = 6)High No clinicians in this category 3 clinicians (SDH score: mean = 7.3; range, 6-9)
“Realistically, half or more of the illnesses that we see are related to substance abuse, whether it’s illicit drugs, alcohol, tobacco. If you throw in other social issues—homelessness, immigration, stress of poverty in general—surely, well over 50%. The inability to address those issues is a source of frustration.” (physician; high EE, high DP; SDH score = 7)
“Even with a nice behavior health system, through social work and all that, I feel sometimes I’m helpless and powerless to give [patients] more. Sure, I can sign my name on and give them health services, but I don’t feel sometimes that’s what they need.” (physician; high EE, high DP; SDH score = 9)DP = depersonalization; EE = emotional exhaustion; SDH = social determinants of health.
Additional Files
Supplemental Appendix
Supplemental Appendix
Files in this Data Supplement:
- Supplemental data: Appendix - PDF file
The Article in Brief
Capacity to Address Social Needs Affects Primary Care Clinician Burnout
Alina Kung , and colleagues
Background Twenty-nine primary care clinicians provided insight into the relationship between patient social needs and physician burnout through semi-structured interviews.
What This Study Found Four key themes appeared throughout these interviews: (1) burnout can affect how clinicians evaluate their clinic�s social needs resources, (2) unmet social needs affect practices by influencing clinic flow, treatment planning, and clinician emotional wellness; (3) social services embedded in primary care clinics buffer against burnout by increasing efficiency, restoring clinicians' medical roles, and improving morale; and (4) clinicians view clinic-level interventions to address patients' social needs as a necessary but insufficient strategy to address burnout.
Implications
- The clinicians noted the importance of social needs interventions being timely, accessible, and tailored to each individual patient, while being responsive to patient feedback. The clinicians were skeptical that referral-based interventions based solely on referrals would adequately address patients' social needs.
