Which kind of doctors experience dramatically lower levels of burnout? Study offers new perspective

A doctor examining a patient's eyes
Doctors with a connection to their community and patients experience less burnout, a study finds. (Getty/monkeybusinessimages)

Physicians in small, independent primary care practices report dramatically lower levels of burnout when compared to the national average.

A new study of 235 providers practicing in 174 small independent primary care practices in New York City found those doctors reported a burnout rate of 13.5% compared to national estimates that 54.4% of doctors report they have symptoms of burnout. “The difference is stark,” lead author Donna Shelley, M.D., a professor in the departments of population health and medicine at NYU Langone Health, said in an interview with FierceHealthcare.

The findings indicate that the independence and sense of autonomy that providers have in these small practices may provide some protection against symptoms of burnout, according to the study in the Journal of the American Board of Family Medicine. 

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The news comes as a separate study highlights the potentially serious consequences of physician burnout. Published in Mayo Clinic Proceedings, that research linked physician burnout to medical errors.

Researchers sent surveys to physicians across the U.S., and among the 6,695 who responded, 3,574, or 54%, reported symptoms of burnout, and 10% of those reported at least one major medical error in the past three months. Burnout may be to blame for more errors than unsafe workplace conditions, the study said.

RELATED: Physician burnout: 1 in 5 doctors want to reduce their clinical hours

Research on physician burnout has focused primarily on hospital settings or large primary care practices.

But healthcare may be able to learn as much by looking at the group that’s not showing high burnout rates as it can by looking at what causes burnout. The researchers in the New York study say that this is the first study that examines the prevalence of burnout among physicians in small independent primary practices: practices with five or fewer physicians.

“So, the obvious question is: What is it about the work environment that results in low burnout rates in small practices?” Shelley said. Those factors can perhaps be translated into other settings where doctors report high rates of emotional exhaustion, stress and depression.

Donna Shelley
Donna Shelley, M.D.
(NYU Langone Health)

In these practices, doctors have a sense of autonomy and are the ones creating the culture of the workplace, Shelley says. They have a say in the decision-making process.

Physicians that described a culture in which individuals have opportunities for growth, and the ability to learn from mistakes by talking and listening to each, reported lower levels of burnout.

Another factor emerged from talking to these doctors. Almost 70% of the practices in the study were solo practices. In many of the practices, doctors are working with an immigrant population and have a strong sense of commitment to their community, she says. Many doctors, particularly if they speak the language of their patients, feel if they were not taking care of those patients, they may have no access to healthcare.

As well as looking at ways of creating a workplace that supports physicians as occurs in these small practices, Shelley says another question is how can the healthcare system help these doctors in small practices remain independent.

“It’s not that these practices are not under duress,” she says, since many face financial stress as they try to adapt to new payment models and face increasing regulations. Yes, despite that stress, the doctors still experience less burnout.

Despite declines in the number of small practices in the United States, primarily due to market forces driving consolidation, close to 70% of all primary care office visits occur in small practice settings, according to the American Medical Association. 

“There’s certainly value. I would hate to see them become extinct,” she says of those small, independent practices.

As of mid-2015, one in four medical practices was hospital-owned. And 2016 marked the first year in which physician practice ownership is no longer the majority arrangement, with physicians evenly distributed between owners and employees: 47.1% of doctors own their own practice, with the same percentage employed and 5.9% independent contractors.

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