Poor control over clinical work associated with burnout among physicians

1. In this cross-sectional survey, poor control over patient load, team composition, and clinical schedule were each associated with burnout among physicians.

2. Poor control over patient load and workload were associated with intent to reduce clinical hours, while poor control over hiring of staff and accountability were each associated with intent to leave current practice.

Evidence Rating Level: 3 (Average)

Study Rundown: Physicians’ control over their work has declined over the past several decades due in part to the increasing change in status from practice owners to employees, the encouragement of physician standardization and commodification, and increased workload with the advent of electronic health records. Existing literature has suggested that intrinsic factors such as autonomy and purpose can reduce feelings of burnout among physicians. This study aimed to examine whether physicians’ perceptions of work control were associated with feelings of burnout and desire for career change. The study found that most physicians felt they had adequate control over their patient load, choice of their clinical team, and their overall workload. The majority of physicians also felt that they were granted sufficient autonomy over that for which they were accountable. However, poor control over patient load, choice of clinical team, clinical schedule, domains of work for which physicians had responsibility, and workload were each associated with burnout. Poor control over patient load and workload were each associated with intent to reduce clinical hours (ITR); poor control over who was hired in their clinical team, domains of work for which physicians had responsibility, and workload were each associated with intent to leave current practice (ITL). The generalizability of this study was limited by its cross-sectional nature, which precludes analysis of causation and potential direction of effect. Further, its lack of representation among smaller physician practice groups and the self-reported nature of outcome measures may have created response bias. Nonetheless, this study emphasizes the potential benefits of increasing physician autonomy in reducing burnout, encouraging physician retention, and ultimately improving continuity and quality of care.

Click to read the study in AIM

Relevant Reading: Working Conditions in Primary Care: Physician Reactions and Care Quality

In-depth [survey]: This study aimed to explore the components of work control and assess whether work control was associated with burnout, ITR, and ITL. Study participants and outcomes were derived from the American Medical Association Organizational Biopsy, a survey aimed to determine workforce wellbeing. The survey was conducted in 19 organizations and responded to by 2339 physicians, yielding a response rate of 48.2% and an average of 117 respondents per organization. Among physicians who responded to the survey, 55.5% (1297 of 2339) were male and 85.9% (2008 of 2339) were full-time clinicians. A total of 61.4% (1318 of 2144) of respondents reported adequate work control, 60.6% (1301 of 2144) adequate control over the members of their clinical team, 49.0% (772 of 1574) adequate control over staff recruitment, 74.6% (1175 of 1574) adequate control over their clinical schedule, 58.3% (692 of 1186) adequate control over workload, and 61.3% (1434 of 2339) enough autonomy given by their organization over their work. Multivariate logistic regression models were then used to assess the correlation between individual work control items and burnout after adjustment for demographic and professional characteristics. Factors associated with burnout were poor control over patient load (odds ratio [OR], 1.35 [95% CI, 1.04 to 1.75]), clinical team members (OR, 1.66 [95% CI, 1.30 to 2.12]), clinical schedule (OR, 1.32 [95% CI, 1.01 to 1.74]), aspects of work for which physicians had responsibility (OR, 1.26 [95% CI, 1.00 to 1.59]), and workload (OR, 3.83 [95% CI, 2.99 to 4.90]). ITR was linked to poor control over patient load (OR, 1.61 [95% CI, 1.21 to 2.13]) and workload (OR, 1.40 [95% CI, 1.07 to 1.83]); ITL was linked to poor control over staff recruitment (OR, 1.61 [95% CI, 1.18 to 2.19]), aspects for which physicians had responsibility (OR, 1.40 [95% CI, 1.05 to 1.87]), and workload (OR, 1.41 [95% CI, 1.03 to 1.93]). Overall, this study showed an association between reduced autonomy at work and increased burnout and desire for reduced work hours or career changes.

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