Physician Burnout Propels Practice Abandonment

A recent study published in JAMA Network Open investigates the frequency of physician burnout, as well as their degrees of professional fulfillment and the factors that influence their intention to leave (ITL) their institution or profession.

Background

According to recent surveys, 6-7% of American physicians quit their practices each year, with the rate of turnover continuing to climb. These departures undermine professional and therapeutic relationships and may disrupt care delivery inside the institution, increasing the pressure on other clinicians.

Physicians leaving the field also contribute to shortages, with attrition rates varying by specialty. Work-life imbalance is a powerful predictor of burnout, which is linked to high physician turnover.

Physicians who see a mismatch between effort and reward in their professions, as well as those who report ITL, are more likely to leave their career. Little is known about causes other than burnout that may lead to turnover and ITL, or about how ITL varies by specialty.

About the study

Researchers used data obtained by the Healthcare Professional Well-being Academic Consortium (PWAC) from physicians across 15 organizations in the current cross-sectional study. From October 2019 to July 2023, respondents were asked to answer questions about burnout, professional fulfillment, and contributing variables. While demographic information was included in the data, it was deidentified in order to safeguard the privacy of the participants.

The well-being of a clinician is attained by a mix of individual variables, work efficiency, and culture influences, according to the idea of reciprocal determinism in social cognitive theory. The survey measured supportive leadership, schedule control, alignment of personal and organizational values, perceived meaningfulness of work, the effect of work on non-work relationships, peer support, and mental health, which included anxiety, sleep impairment, and depression. The key outcome measure was the Professional Fulfillment Index (PFI), which was used to assess work fulfillment.

The dataset was examined using multivariate logistic regression models that predicted ITL based on professional fulfillment and burnout while controlling for gender, subspecialty, age, ethnicity, and race. A later study looked at the links between ITL and variables of physician well-being.

Study Findings

The survey was sent to 37,511 attending-level medical specialists, and 18,719 physicians from 53 medical specialties were included in the analysis because they answered questions about at least one of the study outcome measures. This group included 44.8% males and 42.9% females, as well as 56.6% Whites and 12.8% Asians.

Nearly one-third of the 15,890 respondents who answered questions regarding their ITL reported a moderate or higher Likert scale score of three or more. Men were slightly more likely than women to report this degree of ITL (33% vs. 31.2%), whereas Asian and White physicians were less likely to report greater ITL (28.9% vs. 31.2% vs. 38.9%).

Respondents aged 60 and up had the highest likelihood of reporting ITL, at 40.1%. Anesthesiology, gastroenterology, thoracic surgery, neurological surgery, critical care, and radiology were among the specialties with high ITL rates. The lowest rates were found in pediatric hospital medicine, hospice and palliative care, neuroradiology, physical medicine and rehabilitation, and nuclear medicine.

Women were more likely than men to report burnout, at 42.2% versus 33%, and less likely to report professional fulfillment, at 34.1% versus 45.4%. Burnout was lowest among those over the age of 60, at 23.2%, whereas 49.5% of physicians in this age group reported high levels of professional fulfillment. Non-White and non-Asian physicians reported the most burnout and the least professional fulfillment.

After controlling for medical specialty and demographic characteristics, the multivariate regression models revealed that increasing the burnout score by one point raised the probability of ITL by 52%. Increasing the professional contentment score by one point, on the other hand, lowered ITL chance by 36%.

ITL risk was reduced by factors such as supportive leadership behavior, alignment of personal and organizational values, perceived gratitude, and organizational support related to coronavirus disease 2019 (COVID-19) after controlling for physician burnout, professional fulfillment, and demographic characteristics. Depression and the detrimental influence of work on non-work relationships, on the other hand, were associated with higher ITL risk.

Conclusion

ITL and burnout are common among physicians and vary according to gender, age, race, and specialty. The current study’s innovative findings can be used to establish efforts that give better support for physicians specializing in emergency medicine and other frontline specialties, which are expected to suffer significant shortages in the future.

For more information: Ligibel, J.A., Goularte, N., Berliner, J.I., et al. (2023). Well-being parameters and intention to leave current institution among academic physicians. JAMA Network Open (2023). doi:10.1001/jamanetworkopen.2023.4789