Associations Between Burnout and Practice Organization in Family Physicians

Jessica Creager; Anastasia J. Coutinho, MD, MHS; Lars E. Peterson, MD, PhD

Disclosures

Ann Fam Med. 2019;17(6):502-509. 

In This Article

Abstract and Introduction

Abstract

Purpose: Burnout has been reported to be as high as 63% among family physicians and has negative effects on physicians, patients, and the medical system. There are likely structural causes of burnout, but little is known about the relationship between practice organization and burnout. Our objective was to study this association in family physicians.

Methods: This cross-sectional study uses secondary data supplied by practicing physicians from the 2017 American Board of Family Medicine (ABFM) Family Medicine Certification examination registration questionnaire, a mandatory component of registration, yielding a 100% response rate. Burnout was measured as a positive response to either of 2 validated questions measuring emotional exhaustion and depersonalization. Practice environment was measured with questions on work stressors and teamwork. Logistic regression determined independent associations between burnout and individual and practice characteristics.

Results: Of the 1,437 physicians included, the burnout rate was 43.7%; 33.7% worked in hospital-owned practices and 65.5% reported no ownership stake in their practice. Controlling for personal characteristics and practice organization, being in a hospital-owned practice (odds ratio (OR) = 1.68; 95% CI, 1.14–2.46) and being a partial owner (OR =1.67; 95% CI, 1.13–2.46) were positively associated with burnout. When also controlling for practice environment, no practice organization variable remained associated with burnout.

Conclusion: Burnout in family physicians should not be attributed solely to practice organization. No single practice type or ownership status was independently associated with burnout, which indicates that any practice can attempt to mitigate burnout.

Introduction

Burnout in family physicians is estimated to be as high as 63%, and there is evidence that the problem is worsening.[1] The negative effects of burnout are widespread, with links to physician alcohol use[2] and suicidal ideation,[3] reduced quality of patient care[4,5] and worse patient outcomes,[5–7] and possible overuse of health resources due to increased referrals.[8] Given the high prevalence of burnout and the serious risks, there is an urgent need to uncover the causes of burnout and identify solutions to this issue.

Although many organizational risk factors for burnout have been identified (excessive workload,[9–12] lack of workplace control,[10,11,13,14] and misalignment of physician and organizational values[10,11,13]), there is a scarcity of research linking practice type and ownership status with physician burnout.[15] These aspects of the workplace are particularly relevant considering the major decline in physicians with an ownership stake in their practice. As of 2016, less than 50% of all physicians had an ownership stake in their practice, compared to the nearly 76% with an ownership stake in 1983. Hospital employment of previously independent physicians is associated with conflicts over control of the workplace.[16] When physicians become employees of organizations, they are less able to independently define the values of the organization, leading to possible misalignment. These practice characteristics may be linked to burnout. However, based on the current literature, it is unclear whether a practice organization type is linked with burnout or if an association is mediated through risk factors such as loss of control and misalignment of physician and organizational values. Therefore, our objective was to study the associations between burnout and practice organization and environment in family physicians.

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