Workplace Factors Contribute to Burnout in Family Physicians

Diana Phillips

May 10, 2017

Family physicians who work in a hectic or chaotic environment, those who report high rates of job-related stress, and those who spend time at home working on electronic medical record (EMR) tasks may be particularly vulnerable to burnout, researchers report.

In a study designed to assess workplace factors associated with burnout among family physicians, Monee Rassolian, MD, from Michigan State University, Flint, and colleagues administered an abbreviated burnout survey to a random sample of family physicians applying to take the 2016 American Board of Family Medicine Certification Examination. They report their findings online May 8 in JAMA Internal Medicine.

Twenty-five percent of the final survey sample of 1752 physicians reported symptoms of burnout on the basis of the 10‑item Zero Burnout Program survey, also referred to as the Mini Z survey, developed from the Maslach Burnout Inventory. The Mini Z survey enables the assessment of burnout with a single item that correlates with the emotional exhaustion subscale of the Maslach Burnout Inventory.

Although substantially lower than physician burnout estimates in studies using the Maslach Burnout Survey, the burnout prevalence in this study is similar to that observed among academic general internal medicine physicians using the Mini Z survey, the authors note.

Of those with burnout (n = 441), 57.1% reported working in a hectic, chaotic atmosphere compared with 26.5% of those without burnout, 91.4% reported feeling a great deal of job stress compared with 38.4% of the physicians without burnout, and 62.1% spent excessive time on EMR tasks at home compared with 38.7% physicians without burnout, the authors write.

The workplace factors addressed by the survey include:

  • job satisfaction;

  • job-related stress;

  • control over workload;

  • sufficiency of time for documentation;

  • the atmosphere of the work area on a 5-point scale, where 5 is hectic/chaotic;

  • alignment of professional values with those of department leaders;

  • ability of care team to work together efficiently;

  • time spent on the EMR at home; and

  • proficiency of EMR use.

Bivariate analysis identified associations between burnout and all the work-related factors except proficiency with EMR use, which was similar among physicians with and without symptoms of burnout, the authors report.

Adjusted logistic regression models showed positive independent associations between burnout and job stress (odds ratio [OR], 16.38; 95% confidence interval [CI], 11.49 - 23.37); working in a hectic, chaotic environment (OR, 3.61; 95% CI, 2.86 - 4.55); and excessive time spent on electronic medical records at home (OR, 2.67; 95% CI, 2.12 - 3.38).

Controlling for all variables in the Mini Z survey "attenuated the strength of the associations for all variables," the authors report. The resulting odds ratios for job stress, working in a chaotic environment, and excessive time spent on EMRs at home, respectively, were 9.06 (95% CI, 6.13 - 13.38), 1.42 (95% CI, 1.06 - 1.91), and 1.12 (95% CI, 0.81 - 1.55).

Although variables related to EMRs themselves were not significantly associated with burnout in the analysis controlling for other workplace factors, "insufficiency of time for documentation remained significant," the authors report.

This finding is consistent with those of previous studies, including this linking the administrative tasks required for EMR use to burnout. For example, in one recent study reported by Medscape Medical News, researchers found that primary care physicians lost more than an hour per day sorting through electronic health record notifications independent of all other electronic health record–related tasks. In another study, the prevalence of physician burnout was significantly higher among physicians who used electronic health records than among those who did not, independent of their reported satisfaction with the technology itself.

"This disproportionate time documenting may decrease the potentially protective benefits of patient contact," the authors write. This hypothesis is supported by the findings of the Medscape EHR Report 2016, which showed that more than half of the physicians surveyed felt the administrative tasks associated with the technology reduced the time available for face-to-face patient interaction and the number of patients who can be seen each day.

On the basis of their findings, the authors suggest workplace factors might be an appropriate target for future interventions "to reduce burnout and improve patient care and physician satisfaction."

Two coauthors are employees of the American Board of Family Medicine Foundation. The remaining authors have disclosed no relevant financial relationships.

JAMA Intern Med. Published online May 8, 2017. Abstract

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