Efforts to address physician burnout typically focus either on addressing systemic factors, such as electronic health records and loss of individual autonomy, or on implementing changes focused on helping individuals cope with workplace stress through coaching and mindfulness tools. A new study suggests that reducing burnout requires an organizational-level response that focuses on creating of a medical practice culture that value qualities such as teamwork, open communication, and process improvement.

The study was published in the June issue of Health Affairs. The authors surveyed more than 5000 physicians and advanced practice clinicians at 715 small- to medium- sized practices taking part in the Agency for Healthcare Research and Quality’s EvidenceNOW trial from 2015 to 2017. They measured burnout levels among individual respondents using the Maslach Burnout Inventory. The survey also included questions regarding adaptive reserve—the capacity for organizational learning and development as measured by characteristics such as teamwork, work environment, and leadership.

Practices fell into 1 of 2 categories— zero-burnout or high-burnout practices—with the former having no practice members reporting burnout and the latter with at least 40% of members reporting burnout. Top-line results demonstrated the following:

Solo practices fell into the zero-burnout category more frequently at 30.8% vs 10.6% in the high-burnout category. Conversely, among practices with 6 to 10 clinicians, 7.5% of respondents were in the zero-burnout category compared with 17% in the high-burnout grouping.

Practice ownership is an important factor in burnout: 

53% of clinician-owned practices fell into the zero-burnout category and 37% were in the high-burnout category; 19% of practices owned by a hospital, health system, or health maintenance organization were zero burnout and 37% were high burnout.

Patient volume does not significantly affect differences in burnout levels: 

At practices where clinicians saw 20 or fewer patients per day, 62% were in the zero-burnout vs 66% that were in the high-burnout category. At practices where clinicians saw more than 20 patients, 28% were zero burnout and 32% were high burnout.

In a finding that may have implications for the movement to value-based care, 29% of practices participating in an accountable care organization (ACO) were in the zero- burnout category compared with 53% in the high-burnout category. A spokesperson for the National Association of ACOs called the study sample “biased,” noting that it also controls for other transformational practice activities such as patient-centered medical home recognition and participation in meaningful use.

Looking at zero-burnout practices overall, the authors noted that a common trait is a strong practice culture “in which teamwork, communication, psychological safety, mindfulness of others, facilitative leadership, and understanding that people make and can learn from mistakes are among the key attributes.”

Edwards ST, Marino M, Solberg LI, et al. Cultural and structural features of zero-burnout primary care practices. Health Aff (Millwood). 2021;40(6):928-936. doi:10.1377/hlthaff.2020.02391

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A new study suggests that reducing physician burnout requires an organizational-level response that focuses on creating of a medical practice culture that value qualities such as teamwork, open communication, and process improvement.

Jeff Bendix

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Reducing Burnout Requires an Organizational Response