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Physician burnout at small practices dramatically lower than the national average

The authors say it's the first research of its kind that examines the prevalence of burnout in practices of five physicians or fewer.

Jeff Lagasse, Associate Editor

Physicians who work in small, independent primary care practices -- also known as SIPs -- report dramatically lower levels of burnout than the national average (13.5 percent versus 54.4 percent), according to a study led by researchers at NYU School of Medicine.

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.

Physician burnout is a major concern for the healthcare industry, as it's associated with low job satisfaction and reduced productivity It may also negatively impact quality of care. What's more, burnout can hurt the bottom line. Research has shown, for instance, a consistent relationship between higher levels of physician burnout and lower levels of patient safety and quality of care.

Prior research on physician burnout has focused primarily on hospital settings or large primary care practices. The authors of the new study say it's the first of its kind that examines the prevalence of burnout among physicians in small independent primary practices -- practices with five or fewer physicians. 

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

Researchers examined data collected from 235 physicians practicing in 174 SIPs in New York City. The rate of provider reported burnout was 13.5 percent, compared to the 2014 national rate of 54.4 percent. A 2013 analysis of physician surveys conducted in the United States and Europe found that lower burnout rates were associated with greater perceived autonomy, a quality and safety culture at work, effective coping skills, and less work-life conflict.

Another new study, this one from the Stanford University School of Medicine, found that physician burnout is at least equally responsible for medical errors as unsafe medical workplace conditions, if not more so. Medical errors are common in the U.S., and previous studies estimate these errors are responsible for 100,000 to 200,000 deaths each year.

The researchers sent surveys to physicians in active practice across the country. Of the 6,695 who responded, 3,574 -- 55 percent -- reported symptoms of burnout. Ten percent also reported they had made at least one major medical error during the prior three months, a figure consistent with previous published research, the study said. 

The physicians were also asked to rank safety levels in the hospitals or clinics where they worked using a standardized question to assess work unit safety. The results showed that physicians with burnout had more than twice the odds of self-reported medical error, after adjusting for factors such as work hours, specialty, fatigue and work unit safety rating. Low safety grades in work areas were also found to be associated with three to four times the likelihood of medical error.

The study also showed that rates of medical errors actually tripled in work areas, even those ranked as extremely safe, if physicians working had high levels of burnout -- indicating that burnout may be an even a bigger cause of medical error than a poor safety environment.

Twitter: @JELagasse
Email the writer: jeff.lagasse@himssmedia.com

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