Loneliness, Burnout, and Other Types of Emotional Distress Among Family Medicine Physicians

Results From a National Survey

Samuel Ofei-Dodoo, PhD, MPA, MA; Rebecca Mullen, MD, MPH; Andrew Pasternak, MD, MS; Christina M. Hester, PhD, MPH; Elisabeth Callen, PhD, GStat; Edward James Bujold, MD; Jennifer K. Carroll, MD, MPH; Kim S. Kimminau, PhD

Disclosures

J Am Board Fam Med. 2021;34(3):531-541.

Conclusion

The prevalence of loneliness in practicing family medicine physicians is high and is significantly associated with burnout and depression. Our findings contribute to the growing body of evidence demonstrating the disproportionate amount of emotional distress experienced by physicians. In response, health care systems, employers, and payers need to prioritize understanding and addressing the factors relating to physician wellbeing. Future research ought to study the temporal relationship between loneliness, burnout, depression, and the factors related to the manifestation of these conditions to inform effective interventions.

1 2 3 4 5

Next Section

This article was externally peer reviewed.

Funding
None.

Table 1. Respondents' Characteristics, (n = 401)
Characteristic	N (%)*	Characteristic	N (%)
Gender		Primary employer
Male	171 (46.3)	Self-employed	80 (20.0)
Female	196 (53.1)	Physician group	71 (19.2)
Other	2 (0.6)	University owned clinic or hospital	48 (13.0)
Missing	33	Private for-profit hospital or health system	20 (5.4)
Age, years		Private non-profit hospital or health system	86 (23.3)
Mean ± SD	50.2 ± 11.1	Managed care or insurance company	10 (2.7)
Age group		Federal, state, or local government, community board, etc.	25 (6.8)
25–34	26 (7.1)	Locum tenens group/staffing organization	3 (0.8)
35–44	99 (27.0)	Medical school	10 (2.7)
45–54	111 (30.3)	Other	16 (4.3)
55–64	84 (23.0)	Missing^†	32
≥65	46 (12.6)	Primary patient care location
Missing^†	35	Privately-owned medical practice	171 (46.5)
Employment status		Federally Qualified Community Health Center	37 (10.1)
Full-time	331 (84.4)	Other clinic	104 (28.3)
Part-time	49 (12.5)	Hospital (not emergency department)	7 (1.9)
Fully retired	8 (2.0)	Hospital (emergency department)	3 (0.8)
Not in workforce for other reasons	4 (1.0)	Urgent care facility	12 (3.3)
Missing^†	9	Institutional residential facility (student health, prisons, nursing homes)	12 (3.3)
Specialty		Do not see patients in primary setting	13 (3.5)
Family medicine	359 (97.6)	Other	9 (2.4)
General internal medicine	2 (0.5)	Missing^†	33
Emergency medicine	1 (0.3)	Percentage of work time in clinical practice
Pediatrics	—	<50%	94 (24.3)
Obstetrics/gynecology	—	50%	13 (3.4)
Other	6 (1.6)	>50%	280 (72.4)
Missing^†	33	Missing	14
Years in clinical practice		Percentage of work time in administration/managerial
Mean ± SD	18.9 ± 11.3	<50%	344 (88.9)
Minimum	<1 (0.8)	50%	10 (2.6)
Maximum	51 (0.3)	>50%	33 (8.5)
Missing^†	33	Missing	14
Practice location		Percentage of work time in research
Urban	307 (85.0)	<50%	386 (96.3)
Large rural	26 (7.2)	50%	-
Small rural	21 (5.8)	>50%	1 (0.3)
Isolated	7 (1.9)	Missing^†	14
Missing^†	40	Percentage of work time in teaching
Membership		<50%	375 (96.9)
AAFP Member Insight Exchange	288 (71.8)	50%	4 (1.0)
AAFP NRN Member	113 (28.2)	>50%	8 (2.1)
		Missing^†	14

AAFP, American Academy of Family Physicians; NRN, National Research Network.
*Results presented as number (N) and percentage (%) unless denoted otherwise.
^†The number of physicians who completed the survey but did not provide an answer to this specific question. Missing responses were excluded from the total before percentages were calculated.

Table 2. Loneliness, Burnout, Depression, and Fatigue Among Physicians Who Participated in the Study, (n = 401)
Characteristic	All Participants (n = 401)	Female (n = 196)	Male (n = 171)	P value
	N (%)*	N (%)*	N (%)*
Loneliness
Mean ± SD	5.3 ± 1.9	5.6 ± 1.9	5.1 ± 1.9	.012
Prevalence of loneliness
Screened as lonely	165 (44.9)	95 (48.7)	68 (40.5)	.091
Screened as not lonely	202 (55.0)	100 (51.3)	100 (59.5)	.211
Missing^†	34	1	3
Burnout Index^‡
Emotional exhaustion: high score^f	135 (33.7)	84 (43.1)	51 (30.4)	.008
Depersonalization: high score^f	138 (34.4)	84 (43.1)	54 (32.1)	.019
Burned out	181 (45.1)	111 (56.9)	70 (41.7)	.004
Depression
Screened positive for depression	163 (44.3)	100 (51.0)	63 (36.8)	.004
Missing^†	33	—	—
Fatigue^§
Mean ± SD	5.8 ± 2.4	5.3 ± 2.4	6.3 ± 2.3	<.001
Level of fatigue in the past week
Low	182 (53.1)	82 (44.8)	99 (63.1)	<.001
High	161 (46.9)	101 (55.2)	58 (36.9)	<.001
Missing^†	58	13	14

*Results presented as number (N) and percentage (%) unless denoted otherwise.
^†The number of physicians who completed the survey but did not provide an answer to this specific question. Missing responses were excluded from the total before percentages were calculated.
^‡We assessed burnout using 2 single-item measures for emotional exhaustion and depersonalization adapted from the full Maslach Burnout Inventory.
^fHigh score on Emotional Exhaustion and/or Depersonalization subscale of the Maslach Burnout Inventory.
^§Scores ranged from 0 to 10, with a low mean fatigue score suggesting higher or worsened fatigue.
SD, standard deviation.

Table 3. Odds Ratios for Independent Variables and Loneliness, (n = 401)
Variable	Odds Ratio (95% CI)	P value
Age, years
25–34	1.86 (0.87–3.95)	.534
35–44	1.30 (0.63–2.70)	.103
45–54	2.35 (1.13–4.93)	.386
55–64	1.33 (0.48–3.66)	.088
>64	Reference	—
Gender
Female	1.40 (0.92–2.12)	.999
Male	Reference	—
Employment status
Part-time	1.28 (0.69–2.38)	.152
Full-time	Reference
Years in clinical practice (for additional year in practice)	1.02 (1.00–1.04)	.019
Practice location
Urban	0.57 (0.10–3.38)	.861
Large rural	0.97 (0.18–5.29)	.979
Small rural	1.13 (0.25–5.13)	.487
Isolated	Reference
Membership
AAFP Member Insight Exchange	1.11 (0.69–1.79)	.662
AAFP NRN member	Reference
Depression
Screened positive	5.08 (4.64–7.94)	<.001
Screen negative	Reference	—
Manifestations of burnout
Burned out	4.61 (2.96–7.19)	<.001
Not burnout	Reference	—
Emotional exhaustion
High score	7.19 (4.03–12.02)	<.001
Moderate score	2.85 (1.59–5.10)	<.001
Low score	Reference	—
Depersonalization
High score	4.76 (2.58–8.77)	<0.001
Moderate score	1.45 (0.79–2.65)	.251
Low score	Reference	—
Level of fatigue
High degree	4.63 (1.91–7.63)	<0.001
Low degree	Reference	—

AAFP, American Academy of Family Physicians; CI, confidence interval; NRN, National Research Network.

Table 4. Relationship of Burnout, Depression, and Fatigue with Loneliness Among the Physicians
Variable	Loneliness		χ²	P value	Phi
Variable	Lonely N (%)	Nonlonely N (%)	χ²	P value	Phi
Manifestation of burnout			47.95	<.001	0.357
Present	114 (69.1)	67 (37.0)
Not present	51 (27.4)	135 (72.6)
Total	165 (45.0)	202 (55.0)
Depression			55.10	<.001	0.384
Screened positive for depression	107 (66.0)	55 (34.0)
Screened negative for depression	56 (27.6)	147 (72.4)
Total	163 (44.7)	202 (55.3)
Level of fatigue			25.32	<.001	0.271
High degree	94 (59.5)	64 (40.5)
Low degree	59 (32.4)	123 (67.6)
Total	153 (45.0)	187 (55.0)

processing....

Loneliness, Burnout, and Other Types of Emotional Distress Among Family Medicine Physicians

Results From a National Survey

Conclusion

Tables

Tables

Tables

Tables

References

Authors and Disclosures

Authors and Disclosures

Most Popular Articles

Email This

Feedback