Doctors in Small Practices See Much Less Burnout

Dentistry Today
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Physicians who work in small, independent primary care practices (SIPs) report dramatically lower levels of burnout than the national average, 13.5% versus the 2014 national rate of 54.4%, according to the New York University (NYU) School of Medicine.

The findings indicate that the independence and sense of autonomy that providers have in SIPs may provide some protection against the symptoms of burnout, which is associated with low job satisfaction, reduced productivity, and poor quality of care.  

Research on physician burnout has focused on hospital settings or large primary care practices. The researchers say this is the first study that examines the prevalence of burnout among physicians in SIPs, which have five or fewer physicians.

Despite declines in the number of SIPs in the United States primarily due to consolidation, close to 70% of all primary care office visits occur in SIPs, according to the American Medical Association.

A 2013 meta-analysis of physician surveys in the United States and Europe found that lower burnout rates were associated with greater perceived autonomy, a quality and safety culture at work, effective coping skills, and less work-life conflict.

“Burnout is about the practice culture and infrastructure in which primary care doctors work. So the obvious question is what is it about the work environment that results in low burnout rates in small practices?” said Donna Shelley, MD, professor of population health and medicine at the NYU School of Medicine and the study’s senior author.

“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 changes to support primary care doctors in a way that would reduce the factors that are leading to burnout,” Shelley said.

The researchers examined data collected from 235 physicians practicing in 174 SIPs in New York City. The data was part of the HealthyHearts NYC trial, which is funded by the Agency for Healthcare Research and Quality’s EvidenceNOW national initiative.

Each physician answered a multiple-choice question with response options indicating various levels of burnout. Options ranged from no symptoms of burnout to feeling completely burned out and questioning whether to continue practicing medicine.

The question was validated against the Maslach Burnout Inventory, a nationally recognized measure that identifies occupational burnout. Physician respondents were categorized as burned out if they checked one of the last three options in the question.

Physicians also were asked about the culture of their practices. The tool specifically measures “adaptive reserve,” or a culture where individuals have opportunities for growth and the ability to learn from mistakes by talking and listening to each other.

The physicians who described this kind of culture in their practice reported lower levels of burnout. Practices where employees feel included in decisions and have control over their environment have “high adaptive reserve,” Shelley said.

However, Shelley is careful not to minimize the challenges that physicians working in solo practices or SIPs face. Even though their burnout rates are lower, she said, many are struggling financially, and many are on call all the time.

“The more we can understand what drives low rates of burnout, the more likely it is that we’ll find solutions to this problem,” said Shelley. “The hope is that out 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 also noted that the findings are representative of physicians in SIPs in New York City so they do not capture burnout rates in other parts of the country. Also, the researchers may have underestimated the number of hours worked by physicians, since hours worked is associated with burnout. There was a lack of data linking physician burnout to patient outcomes as well.

The study was published by the Journal of the American Board of Family Medicine.

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