Why Family Medicine Burnout Is Different (and How Docs Fight Back)

Interviewer: Laurie Scudder, DNP, NP; Interviewee: H. Clifton "Clif" Knight, MD, FAAFP


September 06, 2017

Editorial Collaboration

Medscape &

The Unique Stressors in Family Medicine

Medscape: Are these factors different in family medicine? Are there unique aspects of family medicine practice that have to be addressed in order to mitigate burnout and promote resilience?

Dr Knight: We asked our members about sources of frustration that are unique to family medicine, or at least are exacerbated in family medicine. What we heard loud and clear was that most family physicians chose family medicine for the patient-relationship aspect. Family physicians really like getting to know their patients. They like the continuity of taking care of a patient over the course of years. And they like the comprehensiveness and the variety in family medicine.

But what has happened over time is that, in many cases, the variety of care that family physicians are providing has eroded. That can happen for a number of reasons. One is organizational—the result of an organization deciding that all pediatric care will be delegated to pediatricians, and all women's health care will be delegated to gynecologists. Another limitation can occur when an organization controls the setting in which a physician sees a patient, with family physicians required to delegate hospital care to hospitalists or nursing home care to someone in-house at that facility.

The very things that attract us to family medicine can be lost because we are prevented from developing the relationships and the continuity with our patients. The result is that, instead of family physicians being able to provide the full scope of care, which is the reason why they chose this specialty, their scope becomes limited. Family medicine then becomes office-based and very focused on productivity and RVUs.

Medscape: Are there practice models that are associated with higher levels of satisfaction and less burnout?

Dr Knight: In some of the research we've done internally with our members, we have found a higher level of professional satisfaction among those members who report being owners of their practice versus those members who report being employees. I think that highlights the importance of autonomy and being able to decide how to structure one's own practice rather than having to fit into the business model of an organization that is your employer.

And don't misunderstand me—I am not suggesting that all family physicians want to care for hospitalized patients or deliver babies or provide pediatric care. Rather, they want to have control over their own practice. They want to feel that they made that choice rather than that they've had to fit into the mold of an organization that is making those decisions for them.

Owning a practice is not the only way that some family physicians have enhanced autonomy, however. Many have found real satisfaction and fulfillment by practicing in direct primary care (DPC) models.

Others have chosen the route of fellowships. They find their passion in sports medicine, geriatrics, obesity medicine, diabetes care, hospital medicine—any number of areas. They dive into that 100%, and that's what they want to do. They were trained on a foundation of family medicine. And so they practice sports medicine in a relationship-based approach that is very consistent with family medicine values. Even though they have chosen to narrow their scope, they are still family physicians because of their training, their philosophy, and their approach.

That is one of the wonderful things about family medicine: It is a pathway to a lot of opportunities.


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