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Physician Burnout Rates Remain Low in Small, Independent Practices

Providers in small, independent practices may be less susceptible to physician burnout than those in larger organizations.

Physician burnout rates are lower among small, independent practices.

Source: Thinkstock

By Kate Monica

- Despite the rapid rise of physician burnout nationwide, burnout rates are relatively low among providers in small, urban, independent primary care practices comprising less than five physicians.

This finding comes from a recent Journal of the American Board of Family Medicine (JABFM) study by Blechter et al. at the New York University (NYU) School of Medicine.

Researchers aimed to get a fuller picture of the state of physician burnout in small, independent practices since most existing research about burnout focuses on providers in hospital settings or large primary care practices.

The NYU School of Medicine research team conducted a cross-sectional analysis of data collected from 235 providers practicing in 174 small, independent primary care practices throughout New York City. Data used for the study was collected as part of the HealthyHearts NYC (HHNYC) trial funded through the Agency for Health Care and Quality EvidenceNOW initiative.

About 66 percent of practices involved in the study were solo provider practices, while about 46 percent were patient-centered medical home (PCMH) recognized. Two-hundred and four providers part of the study were physicians, while 31 were nurse practitioners or physician assistants.

Researchers asked providers to use their own definition of burnout and indicate whether they enjoy their work and experience zero symptoms of burnout, experience stress and a lack of energy but do not feel burned out, or experience one or more symptoms of burnout.

Ultimately, researchers found a “remarkably low burnout rate” of 13.5 percent among providers practicing in small, independent practices in New York City.

This reported rate of physician burnout is comparatively much lower than burnout rates found in previous studies.

A January JABFM study of physician burnout in different states found an average of 39.8 percent of young, newly-practicing physicians experienced consistent feelings of emotional exhaustion, while 23.7 percent reported high levels of depersonalization.

In some states, more than 55 percent of physicians reported feeling symptoms of burnout.

Likewise, a 2017 athenahealth survey found almost half of practicing physicians believe they will have trouble maintaining their workload in the long-term.

The especially low rates of physician burnout in small, independent practices indicates there may be benefits to the work environment common among these practices.

“One explanation for this finding could be the autonomy (i.e., control of work environment) associated with owning one's own practice as opposed to working in an integrated health system or Federally Qualified Health Center where providers are subject to greater administrative regulations,” suggested researchers in a discussion of the report.

Additionally, small, independent practices may foster more personal relationships between patients and providers than their larger counterparts. Close patient-provider relationships may contribute to greater job satisfaction and lower burnout rates among physicians.

Notably, researchers found no correlation between hours worked and burnout rates. While striking a suitable work-life balance may help to prevent physician burnout, providers who work more hours than others are no more likely to suffer from burnout.  

“Further study is needed to better characterize the association between work-life balance, hours worked, and burnout among providers working in SIPs,” wrote researchers.

While working hours did not correlate with burnout, researchers found higher adaptive reserve scores were associated with lower burnout rates.

The National Demonstration Project, which studied PCMH implementation, defined adaptive reserve as an organization’s “internal capacity for organizational learning and development.”

“The relationship between adaptive reserve and provider burnout suggests that interventions to reduce burnout in primary care practices should focus on strengthening factors that support organizational capacity for change (i.e., strong communication, leadership supports, innovation),” researchers suggested.

Fostering a strong patient-provider relationship, promoting provider autonomy in the workplace, and ensuring healthcare organizations are capable of development, change, and innovation may help to lower rates of physician burnout in other care settings more susceptible to the problem.

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