Control over clinical work linked to physician burnout, intent to leave practice

Key takeaways:

• About 60% of physicians feel like they have adequate control over various aspects of their clinical work.
• Team composition, schedule setting, patient load and workload were independently linked to burnout.

Less perceived control over clinical work was associated with increased physician burnout and intent to reduce clinical hours or leave their practice, according to research published in Annals of Internal Medicine.

A physician’s perception of control over their clinical work is thought to be linked to career intentions and burnout, Christine A. Sinsky, MD, vice president of professional satisfaction at the AMA, and colleagues wrote. But over the last few decades, physicians’ influence and control over their workload and care environment has declined.

“This trend has been driven by many forces, including the move from physician practice ownership to employment, the application of an industrial approach favoring standardization over customization and cultural changes in the relationship between organizations and their physicians with a shift toward commodification, measurement and culpability,” they wrote. “With these shifts, physicians often feel treated as a unit of productivity to be manipulated and afforded little control over their work environment.”

Sinsky and colleagues’ cross-sectional, multi-institution study included 2,339 physicians in 19 large health care organizations in the United States. The researchers found that a lack of control over some work aspects was linked to both burnout and the intention to leave an organization or reduce clinical effort.

More specifically, among the 2,144 respondents:

• 49% reported that they had adequate control over hiring of staff;
• 60.6% reported they had adequate control over their clinical team’s membership;
• 61.3% reported that they had adequate control over their workload;
• 61.4% reported that they had adequate control over their patient load; and
• 74.6% reported that they had adequate control over their clinical schedule.

There were several aspects of work control that were independently related to burnout, including clinical team composition, clinical schedule setting, volume of patient load and workload. Factors like control over the hiring of staff was not linked to burnout. Additionally, only control over workload and patient volume were independently linked to the intention to reduce clinical effort, while control over hiring of staff and workload were independently connected with the intention to leave one’s position.

In light of the findings, Sinsky and colleagues wrote that efforts to improve employee retention and reduce burnout should consider how physicians can gain more control over their clinical work environment, when appropriate.

“Ensuring adequate control over the clinical work environment should be considered one component of a holistic strategy to reduce burnout and retain physicians,” they concluded. “Reductions in burnout and turnover, in turn, have the potential to ensure adequate access to care and foster continuity and quality.”