Associations Between Burnout and Practice Organization in Family Physicians

Jessica Creager; Anastasia J. Coutinho; Lars E. Peterson

doi:10.1370/afm.2448

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Conclusion understates results
David H. Thom

Published on: 13 November 2019

Published on: (13 November 2019)
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Conclusion understates results
David H. Thom, Clinical Professor
In their article examining the association between physician burnout and practice organization, Creager et al conclude that their results indicate "any practice can attempt to mitigate burnout." In looking at their data, I reached a different conclusion - that physicians working in hospital-owned practices are significantly more likely to be burned out, even after adjusting for personal characteristics and practice owne...
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In their article examining the association between physician burnout and practice organization, Creager et al conclude that their results indicate "any practice can attempt to mitigate burnout." In looking at their data, I reached a different conclusion - that physicians working in hospital-owned practices are significantly more likely to be burned out, even after adjusting for personal characteristics and practice ownership.
I base this conclusion on the results from Model 2 (Table 5), which I believe is the most appropriate of the three multivariate models presented. Model 3, which adjusts for "practice environment," appears to over-adjust by including variables that are likely to be, at least in part, proxies for physician burnout and not solely a description of the practice environment. For example, feeling "a great deal of job stress" seems to be a characterization of the impact of the environment on the physician, rather than a description of the work environment per se. Not surprisingly, this variable is strongly correlated with burnout (OR=4.0, 95% CI 3.0-5.1). Adjusting for this variable would be expected to inappropriately attenuate the strength of associations between burnout and other variables in the model.
The authors do not provide any justification for defining the practice environment primarily in terms of physician satisfaction. While adjusting for percent vulnerable patients seems justified, doing so would be unlikely to substantially affect the association between hospital ownership of practice and burnout. (This, of course, could be determined by creating a model with this percent vulnerable patients plus personal and practice organization variables).
Focusing on the increased risk of burnout for family physicians working in hospital-owned practices should raise questions about how these practices differ in operation from non-hospital-owned practices, based on observational data rather than on physician satisfaction.
Competing interests: None declared
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Competing Interests: None declared.