Primary care doctors experience more burnout and anxiety than other healthcare professionals: research

Primary care physicians experience more burnout and anxiety than other healthcare professionals, and this could likely worsen from the impact of the COVID-19 pandemic, a recent study found.

The research, led by the College of Health and Human Services at George Mason University, found that primary care physicians reported burnout at twice the rate of other health care professionals in primary care practices.

Physicians who experienced increasing anxiety and withdrawal were more than three times as likely to report burnout compared to those who did not experience high levels of these issues. Anxiety significantly raised the odds of burnout across healthcare professionals, according to the research.

Researchers found that rates of burnout varied by profession in primary care practices. Physicians reported the highest rates of burnout at 31.6%, nearly twice the rate of other staff in these practices: 17.2% of advanced practice clinicians, 18.9% of clinical support staff and 17.5% of administrative staff.

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The study, published in the Journal of the American Board of Family Medicine, is one of the few that have examined anxiety as a component of burnout and the rate of burnout among different professionals in a primary care practice, according to researchers.

The goal of the study was to examine whether individual behaviors and attitudes towards major disruptive change affect workplace burnout.

Physician burnout has been associated with problems such as turnover, loss of productivity and adverse health behaviors. 

“Burnout is a syndrome characterized by high emotional exhaustion, high depersonalization, and a low sense of personal accomplishment from work,” said Debora Goldberg, Ph.D., associate professor of health administration and policy, who led the study.

“It is important to understand how health care professionals respond to these changes and if certain groups are more likely to experience burnout and why. This is critical due to the tremendous amount of change taking place in the health care industry, projected physician and nurse shortages, and most recently the extraordinary responsibilities placed on them during the COVID-19 pandemic.”

The research team surveyed 1,273 healthcare professionals from 154 small- and medium-sized primary care practices in Virginia. They used the Change Diagnostic Index to assess the participants’ feelings, emotions and attitudes following the organizational and technological change.

Workplace burnout in primary care is a critical issue that was induced, in part, by major transformations to care delivery and administrative processes, the researchers said. Small- to medium-sized practices, defined as those with one to 15 providers, experience more challenges during major disruptive change efforts.

Primary care physicians, advanced practice clinicians, and staff experience a tremendous number of workplace changes brought about by the adoption and use of electronic health records and other information technology and transformation to new care delivery models such as a patient-centered medical home or accountable care organization, according to the researchers.

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Primary care providers also face challenges such as the transfer of practice ownership and compliance with numerous regulatory and payer requirements.

"This research indicates how much burden primary care physicians are carrying through all these different transformations required by healthcare, even to just remain in business. We are seeing a significant level of stress for these physicians," Victoria Grady, assistant professor at George Mason University’s School of Business and a study author, told FierceHealthcare.

The study was conducted before the COVID-19 pandemic, and the data can be used as a baseline for addressing burnout among primary care physicians, Grady said.

"We were looking at burnout in the context of transformation and change going on in physician practices. And look at where we are with COVID-19 and it’s even more significant," she said. "There is an uncertain future ahead of us and there is more potential for additional levels of burnout and change as a result of the pandemic and what it has done to shake U.S. healthcare to its very core."

Understanding individual behaviors and attitudes towards disruptive change may help practice leaders and policymakers develop strategies to reduce burnout among healthcare professionals.

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The researchers recommend that policymakers consider influences on healthcare professionals when developing new programs and regulatory requirements.

Practice leaders also may need external support to strengthen the work environment and to monitor the level and source of anxiety, withdrawal, conflict and loss of interest experienced by physicians and other healthcare professionals during major changes.

"Many practices are going forward without any formal support mechanism or process for how that change will be rolled out in that organization," Grady said. "Organization leaders need to work with their physician teams and employees proactively as they transition through changes."

“This is not just a physician problem,” Goldberg said in a statement. “These findings tell us that we need to prioritize understanding and addressing clinician burnout at a system level and at a local level. The human cost, as well as significant physician shortages expected in the future, make this a critical public health concern.”