Article Figures & Data
Tables
Characteristics No. (%) Personal Age, y <40 143 (10.0) 40-49 552 (38.4) 50-59 484 (33.7) ≥60 258 (18.0) Female sex 656 (45.7) US Medical Graduate 1,124 (78.2) Doctor of Osteopathy degree 163 (11.3) Faculty 484 (33.7) Practice organization Practice type Solo private practice 146 (10.2) Group private practice 346 (24.1) Federally qualified health center 85 (5.9) Other public 71 (4.9) Hospital-owned 484 (33.7) Academic health center 102 (7.1) Health maintenance organization 75 (5.2) Federal 58 (4.0) Miscellaneous 70 (4.9) Practice ownership Self-employed 45 (3.1) Sole owner 197 (13.7) Partial owner 252 (17.5) No ownership 943 (65.6) Practice environment Vulnerable patients, % <10 556 (38.7) 10-49 583 (40.6) ≥50 298 (20.7) I feel a great deal of stress because of my job (agree/strongly agree) 785 (54.6) My control over my workload is (satisfactory/good/optimal) 980 (68.2) Sufficiency of time for documentation is (satisfactory/good/optimal) 667 (46.4) Which number best describes the atmosphere in your primary work area? (4 or 5; 5 = hectic, chaotic) 384 (26.7) My professional values are well aligned with those of my department leaders (agree/strongly agree) 917 (63.8) The degree to which my care team works efficiently together is (satisfactory/good/optimal) 1,333 (92.8) The amount of time I spend on the EHR at home is (excessive/moderately high) 756 (52.6) Satisfaction with hours worked (very satisfied/satisfied) 1,003 (69.8) Burnout (symptoms of emotional exhaustion or callousness) 628 (43.7) EHR = electronic medical record; US = United States.
Characteristics Burned Out
(n = 628), No. (%)Not Burned Out
(n = 809), No. (%)P Value Personal Age, y .0008 <40 68 (47.6) 75 (52.5) 40-49 264 (47.8) 288 (52.2) 50-59 211 (43.6) 273 (56.4) ≥60 85 (33.0) 173 (67.1) Female sex 309 (47.1) 347 (52.9) .017 US Medical graduate 496 (44.1) 628 (55.9) .54 Doctor of Osteopathy degree 64 (39.3) 99 (60.7) .23 Faculty 193 (39.9) 291 (60.1) .037 Practice organization Practice type .055 Solo private practice 51 (34.9) 95 (65.1) Group private practice 149 (43.1) 197 (56.9) Federally qualified health center 35 (41.2) 50 (58.8) Other public 30 (42.3) 41 (57.8) Hospital-owned 234 (48.4) 250 (51.7) Academic health center 34 (33.3) 68 (66.7) Health maintenance organization 34 (45.3) 41 (54.7) Federal 30 (51.7) 28 (48.3) Miscellaneous 31 (44.3) 39 (55.7) Practice ownership .025 Self-employed 13 (28.9) 32 (71.1) Sole owner 75 (38.1) 122 (61.9) Partial owner 123 (48.8) 129 (51.2) No ownership 417 (44.2) 526 (55.8) Practice environment Vulnerable patients, % .082 <10 233 (41.9) 323 (58.1) 10-49 275 (47.2) 308 (52.8) ≥50 120 (40.3) 178 (59.7) I feel a great deal of stress because of my job (agree/strongly agree) 491 (62.6) 294 (37.5) <.0001 My control over my workload is (satisfactory/good/optimal) 318 (32.5) 662 (67.6) <.0001 Sufficiency of time for documentation is (satisfactory/good/optimal) 184 (27.6) 483 (72.4) <.0001 Which number best describes the atmosphere in your primary work area? (4 or 5; 5 = hectic, chaotic) 244 (63.5) 140 (36.5) <.0001 My professional values are well aligned with those of my department leaders (agree/strongly agree) 315 (34.4) 602 (65.7) <.0001 The degree to which my care team works efficiently together is (satisfactory/good/optimal) 563 (42.2) 770 (57.8) <.0001 The amount of time I spend on the EHR at home is (excessive/moderately high) 393 (52.0) 363 (48.0) <.0001 Satisfaction with hours worked (very satisfied/satisfied) 368 (36.7) 635 (63.3) <.0001 EHR = electronic medical record; US = United States.
Environment Characteristic Solo Private Practice, % Group Private Practice, % FQHC, % Other Public, % Hospital Owned, % Academic Health Center, % HMO, % Federal, % Misc, % Total, % I feel a great deal of stress because of my job (agree/strongly agree) 50.0 56.0 52.9 54.9 56.8 47.0 56.0 62.0 47.1 54.6 My control over my workload is (satisfactory/good/optimal) 74.6 76.9 57.7 70.4 64.3 63.7 58.7 60.3 72.9 68.2 Sufficiency of time for documentation is (satisfactory/good/optimal) 54.8 50.0 36.5 53.5 40.5 44.1 42.7 50.0 61.4 46.4 Which number best describes the atmosphere in your primary work area? (4 or 5; 5 = hectic, chaotic) 17.1 23.4 34.1 29.6 26.7 31.4 45.3 32.8 20.0 26.7 My professional values are well aligned with those of my department leaders (agree/strongly agree) 58.2 69.1 69.4 64.8 61.6 69.6 60.0 55.2 60.0 63.8 The degree to which my care team works efficiently together is (satisfactory/good/optimal) 96.6 96.5 92.9 90.1 89.5 88.2 97.3 93.1 92.9 92.8 The amount of time I spend on the EHR at home is (excessive/moderately high) 45.9 54.3 42.4 43.7 59.7 46.1 54.7 34.5 34.3 52.6 Satisfaction with hours worked (very satisfied/satisfied) 70.6 72.0 70.6 71.8 66.7 71.6 58.7 69.0 85.7 69.8 Vulnerable patients <10% 51.4 52.3 2.4 4.2 38.4 20.6 33.3 56.9 42.9 38.7 Vulnerable patients 10-49% 30.1 37.6 10.6 43.7 52.1 37.3 49.3 31.0 34.3 40.6 Vulnerable patients ≥50% 18.5 10.1 87.1 52.1 9.5 42.2 17.3 12.1 22.9 20.7 EHR = electronic health record; FQHC = federally qualified health center; HMO = health maintenance organization.
Environment Characteristic No Ownership, % Partial Owner, % Self-Employed, % Sole Owner, % Total, % I feel a great deal of stress because of my job (agree/strongly agree) 53.8 60.7 42.2 53.8 54.6 My control over my workload is (satisfactory/good/optimal) 64.9 71.0 84.4 76.7 68.2 Sufficiency of time for documentation is (satisfactory/good/optimal) 44.0 44.8 77.8 52.8 46.4 Which number best describes the atmosphere in your primary work area? (4 or 5; 5 = hectic, chaotic) 28.0 31.0 15.6 17.8 26.7 My professional values are well aligned with those of my department leaders (agree/strongly agree) 63.8 67.9 64.4 58.4 63.8 The degree to which my care team works efficiently together is (satisfactory/good/optimal) 91.1 96.4 91.1 96.5 92.8 The amount of time I spend on the EHR at home is (excessive/moderately high) 52.5 61.1 28.9 47.7 52.6 Satisfaction with hours worked (very satisfied/satisfied) 70.3 67.5 73.3 69.5 69.8 Vulnerable patients <10% 33.3 51.2 33.3 49.8 38.7 Vulnerable patients 10-49% 42.1 43.3 37.8 30.5 19.8 Vulnerable patients ≥50% 24.6 5.6 28.9 19.8 20.7 EHR = electronic health record.
Characteristics Model 1 Personal OR (95% CI) Model 2 Personal and Practice OR (95% CI) Model 3 Personal, Practice, and Environment OR (95% CI) Personal Age, y <40 0.99 (0.68-1.43) 0.99 (0.68-1.45) 0.98 (0.63-1.51) 40-49 Reference Reference Reference 50-59 0.85 (0.66-1.08) 0.87 (0.68-1.12) 0.76 (0.57-1.02) ≥60 0.56 (0.40-0.77) 0.57 (0.41-0.79) 0.54 (0.37-0.78) Female sex 1.14 (0.92-1.42) 1.20 (0.96-1.51) 1.07 (0.82-1.39) US medical graduate 1.20 (0.92-1.56) 1.16 (0.89-1.52) 0.84 (0.61-1.14) Doctor of Osteopathy degree 0.74 (0.53-1.05) 0.71 (0.50-1.01) 0.77 (0.52-1.14) Faculty 0.78 (0.62-0.98) 0.82 (0.64-1.05) 0.91 (0.68-1.21) Practice organization Practice type Solo private practice … 0.69 (0.39-1.21) 0.72 (0.38-1.35) Group private practice … Reference Reference Federally qualified health center … 1.29 (0.73-2.27) 1.02 (0.50-2.05) Other public … 1.30 (0.73-2.31) 1.09 (0.55-2.13) Hospital-owned … 1.68 (1.1-2.46) 1.22 (0.78-1.89) Academic health center … 0.96 (0.54-1.70) 0.75 (0.39-1.47) Health maintenance organization … 1.12 (0.67-1.89) 0.74 (0.40-1.39) Federal … 1.78 (0.95-3.32) 1.21 (0.59-2.51) Miscellaneous Practice ownership … 1.34 (0.75-2.38) 1.46 (0.75-2.86) Self-employed … 0.58 (0.29-1.14) 0.70 (0.3-1.53) Sole owner … 1.50 (0.85-2.65) 1.12 (0.59-2.14) Partial owner … 1.67 (1.13-2.46) 1.32 (0.84-2.06) No ownership … Reference Reference Practice environment Vulnerable patients, % <10 … … Reference 10-49 … … 1.14 (0.86-1.51) ≥50 … … 0.93 (0.62-1.38) I feel a great deal of stress because of my job (agree/strongly agree) … … 3.95 (3.02-5.16) My control over my workload is (satisfactory/good/optimal) … … 0.58 (0.43-0.80) Sufficiency of time for documentation is (satisfactory/good/optimal) … … 0.64 (0.47-0.86) Which number best describes the atmosphere in your primary work area? (4 or 5; 5 = hectic, chaotic) … … 1.37 (1.02-1.86) My professional values are well aligned with those of my department leaders (agree/strongly agree) … … 0.48 (0.36-0.62) The degree to which my care team works efficiently together is (Satisfactory/Good/Optimal) … … 1.29 (0.78-2.15) The amount of time I spend on the EHR at home is (excessive/moderately high) … … 1.16 (0.89-1.52) Satisfaction with Hours Worked (very satisfied/satisfied) … … 0.73 (0.55-0.97) EHR = electronic heatht record; OR = odds ratio; US = United States.
Additional Files
The Article in Brief
Associations Between Burnout and Practice Organization in Family Physicians
Lars E. Peterson , and colleagues
Background With the rate of burnout as high as 63% among family physicians, it is important to identify risk factors for physician burnout.
What This Study Found The relationship between burnout and personal environmental and organizational risk factors was examined in a study of family physicians. A cross-sectional study of 1,437 physicians seeking to continue their American Board of Family Medicine Certification in 2017 was created using data from the examination registration process. Burnout was measured as a positive response to either of two validated questions measuring emotional exhaustion and depersonalization. The study revealed a burnout rate of 43.7%; 33.7% worked in hospital-owned practices with 65.5% having no ownership stake in their practice. Controlling for personal characteristics and practice organization, being in a hospital-owned practice and being a partial owner were positively associated with burnout. When also controlling for practice environment, no practice organization variable remained associated with burnout.
Implications
- The most important predictors of burnout were practice environment factors such as satisfaction with hours worked, control over workload, value alignment with department leaders, and sufficient time for documentation.
