In the JournalsPerspective

Broadening scope of family practice reduces physician burnout

Amanda Weidner
Amanda K. H. Weidner

Early career family physicians who deliver a broader scope of care have significantly lower rates of burnout, according to findings recently reported in Annals of Family Medicine.

Study author Amanda K.H. Weidner, MPH, of the department of family medicine at the University of Washington, told Healio Family Medicine the idea for the study came as she heard friends and colleagues talk about their work and their work-life balance and recognized how problematic burnout could be for health care professionals.

“I started to think about burnout and its associations in the context of family physicians after looking at some data from our graduate follow-up surveys at the University of Washington Family Medicine Residency Network,” Weidner said in an interview.

She and her research colleagues analyzed 1,617 responses from the 2016 National Family Medicine Graduate Survey. They compared self-reports of burnout and measures of scope of practice involving pediatric ambulatory care, obstetrics, inpatient medicine, number of procedures and/or clinical content areas, and delivering care outside the primary practice site.

Weidner and colleagues found that of the 42% of respondents reported burnout more than once a week. After adjusted analysis, practice characteristics significantly linked to lower odds for burnout were practicing inpatient medicine (OR = 0.7; 95% CI, 0.56-0.87) and obstetrics (OR = 0.64; 95% CI, 0.47-0.88).

In addition, bivariate analysis showed components of practice linked to lower burnout rates included providing more procedures/clinical content areas (mean procedures/clinical areas: 7.49 vs. 7.02; P = .02); and working in more settings than the principal practice site (one-plus additional settings: 57.6% vs. 48.4%: P = .001), particularly in the hospital (31.4% vs. 24.2%; P = .002) and patient homes (3.3% vs. 1.5%; P = .02).

“I imagine that a broader scope of care gives more diversity of activity in a family physician’s day, which keeps things more interesting, engaging, and enriching,” Weidner said of the results. “It may be more logistically challenging and maybe more tiring to be moving around to different care locations and to keep up-to-date on a greater variety of clinical knowledge, but it seems that it would be more interesting than what can sometimes feel like a ‘hamster wheel’ of outpatient clinical care seeing as many patients as possible with little diversity in ailments and encounters.”

“We do think it is important, however, to note that forcing all family physicians to practice obstetrics and inpatient medicine is not the take home message of this study. Instead, health systems should make sure these sorts of jobs are available for family physicians who desire to practice the broad scope of care for which they have the training (and that these jobs have enough flexibility and reasonable work effort expectations that they are doable),” she continued.

“Given that studies have shown that physician burnout is extremely costly to health systems (and that comprehensiveness is associated with reduced costs), offering jobs that have flexibility in what is included in the physician’s set of clinical duties seems to be in everyone’s best interest,” Weidner concluded. – by Janel Miller

Disclosure: Weidner reports no relevant financial disclosures. Please see the study for the other authors’ relevant financial disclosures.

Editor's Note: This story has been updated to reflect a revision to the original source article.

Amanda Weidner
Amanda K. H. Weidner

Early career family physicians who deliver a broader scope of care have significantly lower rates of burnout, according to findings recently reported in Annals of Family Medicine.

Study author Amanda K.H. Weidner, MPH, of the department of family medicine at the University of Washington, told Healio Family Medicine the idea for the study came as she heard friends and colleagues talk about their work and their work-life balance and recognized how problematic burnout could be for health care professionals.

“I started to think about burnout and its associations in the context of family physicians after looking at some data from our graduate follow-up surveys at the University of Washington Family Medicine Residency Network,” Weidner said in an interview.

She and her research colleagues analyzed 1,617 responses from the 2016 National Family Medicine Graduate Survey. They compared self-reports of burnout and measures of scope of practice involving pediatric ambulatory care, obstetrics, inpatient medicine, number of procedures and/or clinical content areas, and delivering care outside the primary practice site.

Weidner and colleagues found that of the 42% of respondents reported burnout more than once a week. After adjusted analysis, practice characteristics significantly linked to lower odds for burnout were practicing inpatient medicine (OR = 0.7; 95% CI, 0.56-0.87) and obstetrics (OR = 0.64; 95% CI, 0.47-0.88).

In addition, bivariate analysis showed components of practice linked to lower burnout rates included providing more procedures/clinical content areas (mean procedures/clinical areas: 7.49 vs. 7.02; P = .02); and working in more settings than the principal practice site (one-plus additional settings: 57.6% vs. 48.4%: P = .001), particularly in the hospital (31.4% vs. 24.2%; P = .002) and patient homes (3.3% vs. 1.5%; P = .02).

“I imagine that a broader scope of care gives more diversity of activity in a family physician’s day, which keeps things more interesting, engaging, and enriching,” Weidner said of the results. “It may be more logistically challenging and maybe more tiring to be moving around to different care locations and to keep up-to-date on a greater variety of clinical knowledge, but it seems that it would be more interesting than what can sometimes feel like a ‘hamster wheel’ of outpatient clinical care seeing as many patients as possible with little diversity in ailments and encounters.”

“We do think it is important, however, to note that forcing all family physicians to practice obstetrics and inpatient medicine is not the take home message of this study. Instead, health systems should make sure these sorts of jobs are available for family physicians who desire to practice the broad scope of care for which they have the training (and that these jobs have enough flexibility and reasonable work effort expectations that they are doable),” she continued.

“Given that studies have shown that physician burnout is extremely costly to health systems (and that comprehensiveness is associated with reduced costs), offering jobs that have flexibility in what is included in the physician’s set of clinical duties seems to be in everyone’s best interest,” Weidner concluded. – by Janel Miller

Disclosure: Weidner reports no relevant financial disclosures. Please see the study for the other authors’ relevant financial disclosures.

Editor's Note: This story has been updated to reflect a revision to the original source article.

    Perspective
    Clif Knight

    Clif Knight

    When the American Academy of Family Physicians looks at professional satisfaction and burnout among its members, one of the most common themes is that physicians feel a lack of autonomy and self-control and not having enough time to devote to patients are some of the most common reasons for burnout. This study is also entirely consistent with how AAFP tries to connect or reconnect members to their professional purpose. Consequently, I’m not surprised by the findings of Weidner, et al.

    Though comprehensiveness of care is one of the reasons many would-be doctors choose family medicine, there are barriers that prevent some of these physicians from engaging in this full scope of practice. Some of this is due to business or financial models: It may be in some health care organizations it’s felt that it’s more efficient for family physicians to focus on seeing patients in their office as opposed to in the patients’ home, in a hospital, or in a nursing home. In other areas, the care of children has been directed just to pediatricians, obstetric care is limited to obstetricians.

    AAFP feels that finding solutions to decreasing burnout, improving well-being, and increasing satisfaction among physicians of highest priority. The AAFP believes strongly that simply decreasing burnout is not enough, we need to strive for improving well-being and for physicians to feel they are actually thriving professionally. We hope that evidence, such as Weidner et al, can help influence the way health care systems of all sizes develop their business models that enables the practice to be fiscally sound and have physicians who are well or thriving.

    • Clif Knight, MD
    • senior vice president of education, AAFP

    Disclosures: Knight is senior vice president of education, AAFP

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