A new report in the Journal of the American Board of Family Medicine found that physician burnout in small, independent primary care practices isn’t nearly as much of a problem as in other operations.
About 13.5% of physicians in such primary care practices in New York City reported burnout — a much lower figure compared to the national average of 54.4%.
The researchers, led by Donna Shelley, professor of population health and medicine at NYU School of Medicine, said the finding shows that the independence and sense of autonomy found in small practices may protect doctors from feeling worn out or wearied by their work.
Physician burnout is a problem that may get worse with expected doctor shortages and an aging patient population on the horizon. Burnout can lead to negative quality of care, resulting in poorer patient outcomes.
To understand the phenomenon, the researchers examined information collected from 235 doctors from 174 small, independent practices in New York City. Small practices were defined as five physicians or fewer. The data were collected in tandem with the HealthyHearts NYC trial and part of the Agency for Healthcare Research and Quality’s Evidence NOW initiative.
Participating physicians answered a multiple choice question that collated various levels of burnout ranging from no burnout to questioning whether to continue practicing medicine. They were also asked about the culture of their practices.
Shelley said in a statement that doctors who believe they’re part of the decision-making process and feel control over their work environment are less likely to feel levels of burnout. She noted that burnout is connected to the practice culture and infrastructure where the primary practice doctors work.
However, despite lower burnout levels, small, independent practices face other problems, including work/life balance and finances.
“It’s important to study the group that’s NOT showing high burnout to help us create environments that foster lower burnout rates. The good news is that a culture and systems can be changed to support primary care doctors in a way that would reduce the factors that are leading to burnout,” Shelley said.
Healthcare companies should understand what drives burnout before working on solutions, she said. “The hope is that our research can inform ways for larger systems to foster autonomy within practices so that there is space to carve out a work environment that is aligned with doctors’ needs, values and competencies,” Shelley added.
Of course, the study's generalizability is weak, as researchers only studied NYC physicians. To understand what’s happening in all corners of the U.S., researchers will need to expand these kinds of surveys to a broader segment of the country.
Along with contributing to worse care, burnout is expensive for the healthcare industry, costing hospitals and health systems as much as $1.7 billion a year. Burnout-related physician turnover costs as much as $17 billion annually.
A recent Medscape survey found the problem could be even worse than previously reported. That survey said nearly two-thirds of U.S. physicians feel burned out (42%), depressed (15%) or both (14%). More than half of physicians in that survey suggested that fewer bureaucratic tasks could help lessen burnout. Nearly 40% said shorter working days would help relieve burnout.
EHRs were also cited as a source of burnout for one-quarter of respondents. That’s consistent with an Annals of Family Medicine paper last September that reported primary care physicians spent more than half of their workday on EHR tasks.