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Research ArticleOriginal Research

Indicators of Workplace Burnout Among Physicians, Advanced Practice Clinicians, and Staff in Small to Medium-Sized Primary Care Practices

Debora Goetz Goldberg, Tulay G. Soylu, Victoria M. Grady, Panagiota Kitsantas, James D. Grady and Len M. Nichols
The Journal of the American Board of Family Medicine May 2020, 33 (3) 378-385; DOI: https://doi.org/10.3122/jabfm.2020.03.190260
Debora Goetz Goldberg
From George Mason University, Department of Health Administration and Policy, Fairfax, VA (DG, TGS, PK); George Mason University, School of Business, Fairfax, VA (VMG); Pivot Point Business Solutions (JDG); George Mason University, Center for Health Policy Research and Ethics, Fairfax, VA (LMN).
PhD, MHA, MBA
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Tulay G. Soylu
From George Mason University, Department of Health Administration and Policy, Fairfax, VA (DG, TGS, PK); George Mason University, School of Business, Fairfax, VA (VMG); Pivot Point Business Solutions (JDG); George Mason University, Center for Health Policy Research and Ethics, Fairfax, VA (LMN).
PhD, MHA, MBA
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Victoria M. Grady
From George Mason University, Department of Health Administration and Policy, Fairfax, VA (DG, TGS, PK); George Mason University, School of Business, Fairfax, VA (VMG); Pivot Point Business Solutions (JDG); George Mason University, Center for Health Policy Research and Ethics, Fairfax, VA (LMN).
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Panagiota Kitsantas
From George Mason University, Department of Health Administration and Policy, Fairfax, VA (DG, TGS, PK); George Mason University, School of Business, Fairfax, VA (VMG); Pivot Point Business Solutions (JDG); George Mason University, Center for Health Policy Research and Ethics, Fairfax, VA (LMN).
PhD
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James D. Grady
From George Mason University, Department of Health Administration and Policy, Fairfax, VA (DG, TGS, PK); George Mason University, School of Business, Fairfax, VA (VMG); Pivot Point Business Solutions (JDG); George Mason University, Center for Health Policy Research and Ethics, Fairfax, VA (LMN).
DMD
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Len M. Nichols
From George Mason University, Department of Health Administration and Policy, Fairfax, VA (DG, TGS, PK); George Mason University, School of Business, Fairfax, VA (VMG); Pivot Point Business Solutions (JDG); George Mason University, Center for Health Policy Research and Ethics, Fairfax, VA (LMN).
PhD
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Article Figures & Data

Tables

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    Table 1.

    Distribution of Health Care Professional Groups and Burnout (n = 1273)

    ParameterSample, n (%)Burnout
    No, n (%)Yes, n (%)P Value*OR (95% CI)† Burnout
    Burnout total1024 (80.1)249 (19.5)
    Health Care Professionals0.002
    Physicians139 (11.0)93 (68.4)43 (31.6)1.75 (1.09-2.82)
    Advanced practice clinicians‡99 (7.8)82 (82.8)17 (17.2)1.01 (0.54-1.88)
    Clinical support staff§451 (35.6)365 (81.1)85 (18.9)1.29 (0.87-1.91)
    Administrative staff‖578 (45.6)477 (82.5)101 (17.5)Reference
    • ↵* The P value is based on χ2 analysis testing the association between burnout and the type of health care professional.

    • ↵† OR stands for odds ratios calculated from a logistic regression model that has been adjusted for practice size, single- or multispecialty practice, whether a practice is located in an underserved area, and number of hours worked per week

    • ↵‡ Advanced practice clinicians include nurse practitioners and physician assistants.

    • ↵§ Clinical support staff includes licensed practical nurses and medical assistants.

    • ↵‖ Administrative staff includes office managers, receptionists, and medical billing professionals.

    • Bold text indicates statistically significant finding.

    • OR, odds ratio; CI, confidence interval.

    • View popup
    Table 2.

    Differences in the Change Diagnostic Index Domains by Health Care Professional Role at the Practice (n = 1273)

    Domains of the Change Diagnostic IndexSample Mean (SD)Physicians Mean (SD)Advanced Practice Clinicians* Mean (SD)Clinical Support Staff† Mean (SD)Administrative Staff‡ Mean (SD)P Value
    Global2.19 (0.75)2.29 (0.82)2.21 (0.71)2.19 (0.76)2.16 (0.73)0.332
    Anxiety2.50 (0.84)2.77 (0.88)2.57 (0.83)2.46 (0.83)2.44 (0.83)0.000
    Frustration1.83 (0.71)1.76 (0.71)1.80 (0.73)1.85 (0.72)1.83 (0.70)0.627
    Delayed development2.00 (0.72)1.98 (0.69)1.98 (0.66)2.02 (0.72)1.99 (0.73)0.911
    Rejection of environment1.97 (0.75)2.01 (0.78)2.04 (0.71)1.99 (0.77)1.94 (0.74)0.438
    Refusal1.74 (0.67)1.66 (0.64)1.72 (0.63)1.78 (0.71)1.72 (0.64)0.266
    Withdrawal1.70 (0.70)1.60 (0.76)1.69 (0.66)1.73 (0.72)1.71 (0.68)0.353
    • ↵* Advanced practice clinicians include nurse practitioners and physician assistants.

    • ↵† Clinical support staff includes licensed practical nurses and medical assistants.

    • ↵‡ Administrative staff includes office managers, receptionists, and medical billing professionals.

    • Bold text indicates statistically significant finding.

    • SD, standard deviation.

    • View popup
    Table 3.

    Logistic Regression for Burnout among Health Care Professionals Based on the Change Diagnostic Index (n = 1273)

    The Change Diagnostic IndexEntire Sample Burnout, OR (95% CI)*Physicians Burnout, OR (95% CI)*Advanced Practice Clinicians† Burnout, OR (95% CI)*Clinical Support Staff‡ Burnout, OR (95% CI)*Administrative Staff§ Burnout, OR (95% CI)*
    Global0.83 (0.55–1.23)1.19 (0.43–3.34)0.22 (0.02–2.24)0.76 (0.37–1.55)0.90 (0.49–1.69)
    Anxiety2.26 (1.67–3.07)3.22 (1.42–7.31)7.97 (1.74–36.5)1.65 (1.02–2.73)2.31 (1.39–3.85)
    Frustration1.64 (1.05–2.56)3.46 (0.65–18.4)4.25 (0.07–245.1)1.32 (0.72–2.42)2.04 (0.89–4.65)
    Delayed development2.03 (1.34–3.08)0.65 (0.22–1.96)8.45 (0.22–326.7)3.89 (1.79–8.49)2.02 (1.01–4.02)
    Rejection of environment1.85 (1.16–2.93)1.93 (0.75–4.93)57.2 (1.56–2109.2)1.69 (0.89–3.21)1.33 (0.57–3.07)
    Refusal0.76 (0.47–1.23)0.61 (0.12–3.07)0.01 (0.0004–3.41)0.82 (0.44–1.53)0.83 (0.39–1.71)
    Withdrawal1.09 (0.75–1.59)4.15 (1.18–14.5)3.52 (0.38–32.3)0.78 (0.39–1.59)0.97 (0.51–1.87)
    • ↵* Adjusted for practice size, single- or multispecialty practice, whether a practice is located in an underserved area, and number of hours worked per week.

    • ↵† Advanced practice clinicians include nurse practitioners and physician assistants.

    • ↵‡ Clinical support staff includes licensed practical nurses and medical assistants.

    • ↵§ Administrative staff includes office managers, receptionists, and medical billing professionals.

    • Bold text indicates a statistically significant finding.

    • OR, odds ratio; CI, confidence interval.

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The Journal of the American Board of Family     Medicine: 33 (3)
The Journal of the American Board of Family Medicine
Vol. 33, Issue 3
May/June 2020
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Indicators of Workplace Burnout Among Physicians, Advanced Practice Clinicians, and Staff in Small to Medium-Sized Primary Care Practices
Debora Goetz Goldberg, Tulay G. Soylu, Victoria M. Grady, Panagiota Kitsantas, James D. Grady, Len M. Nichols
The Journal of the American Board of Family Medicine May 2020, 33 (3) 378-385; DOI: 10.3122/jabfm.2020.03.190260

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Indicators of Workplace Burnout Among Physicians, Advanced Practice Clinicians, and Staff in Small to Medium-Sized Primary Care Practices
Debora Goetz Goldberg, Tulay G. Soylu, Victoria M. Grady, Panagiota Kitsantas, James D. Grady, Len M. Nichols
The Journal of the American Board of Family Medicine May 2020, 33 (3) 378-385; DOI: 10.3122/jabfm.2020.03.190260
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