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Research ArticleOriginal Research

Differences in Occupational Burnout Among Primary Care Professionals

Jessica Clifton, Levi Bonnell, Juvena Hitt, Abigail Crocker, Gail L. Rose, Constance van Eeghen, Rodger Kessler, Kari A. Stephens, Kathryn Teng, Janeen Leon, Brenda Mollis and Benjamin Littenberg
The Journal of the American Board of Family Medicine November 2021, 34 (6) 1203-1211; DOI: https://doi.org/10.3122/jabfm.2021.06.210139
Jessica Clifton
From University of Vermont, Burlington (JC, LB, JH, AC, GLR, CvE, BL); University of Colorado, Aurora (RK); University of Washington, Seattle (KAS, BM); MetroHealth System, Case Western Reserve University, Cleveland (KT, JL).
PhD
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Levi Bonnell
From University of Vermont, Burlington (JC, LB, JH, AC, GLR, CvE, BL); University of Colorado, Aurora (RK); University of Washington, Seattle (KAS, BM); MetroHealth System, Case Western Reserve University, Cleveland (KT, JL).
MPH
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Juvena Hitt
From University of Vermont, Burlington (JC, LB, JH, AC, GLR, CvE, BL); University of Colorado, Aurora (RK); University of Washington, Seattle (KAS, BM); MetroHealth System, Case Western Reserve University, Cleveland (KT, JL).
MPH
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Abigail Crocker
From University of Vermont, Burlington (JC, LB, JH, AC, GLR, CvE, BL); University of Colorado, Aurora (RK); University of Washington, Seattle (KAS, BM); MetroHealth System, Case Western Reserve University, Cleveland (KT, JL).
PhD
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Gail L. Rose
From University of Vermont, Burlington (JC, LB, JH, AC, GLR, CvE, BL); University of Colorado, Aurora (RK); University of Washington, Seattle (KAS, BM); MetroHealth System, Case Western Reserve University, Cleveland (KT, JL).
PhD
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Constance van Eeghen
From University of Vermont, Burlington (JC, LB, JH, AC, GLR, CvE, BL); University of Colorado, Aurora (RK); University of Washington, Seattle (KAS, BM); MetroHealth System, Case Western Reserve University, Cleveland (KT, JL).
DrPH
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Rodger Kessler
From University of Vermont, Burlington (JC, LB, JH, AC, GLR, CvE, BL); University of Colorado, Aurora (RK); University of Washington, Seattle (KAS, BM); MetroHealth System, Case Western Reserve University, Cleveland (KT, JL).
PhD
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Kari A. Stephens
From University of Vermont, Burlington (JC, LB, JH, AC, GLR, CvE, BL); University of Colorado, Aurora (RK); University of Washington, Seattle (KAS, BM); MetroHealth System, Case Western Reserve University, Cleveland (KT, JL).
PhD
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Kathryn Teng
From University of Vermont, Burlington (JC, LB, JH, AC, GLR, CvE, BL); University of Colorado, Aurora (RK); University of Washington, Seattle (KAS, BM); MetroHealth System, Case Western Reserve University, Cleveland (KT, JL).
MD
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Janeen Leon
From University of Vermont, Burlington (JC, LB, JH, AC, GLR, CvE, BL); University of Colorado, Aurora (RK); University of Washington, Seattle (KAS, BM); MetroHealth System, Case Western Reserve University, Cleveland (KT, JL).
MS, RDN, LD
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Brenda Mollis
From University of Vermont, Burlington (JC, LB, JH, AC, GLR, CvE, BL); University of Colorado, Aurora (RK); University of Washington, Seattle (KAS, BM); MetroHealth System, Case Western Reserve University, Cleveland (KT, JL).
MPA, MPH
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Benjamin Littenberg
From University of Vermont, Burlington (JC, LB, JH, AC, GLR, CvE, BL); University of Colorado, Aurora (RK); University of Washington, Seattle (KAS, BM); MetroHealth System, Case Western Reserve University, Cleveland (KT, JL).
MD
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    Figure 1.

    Boxplot of burnout domain scores collected between 2018 and 2019 by professional role.

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    Table 1.

    Descriptive Statistics of Demographic Characteristics Collected Between 2018 and 2019 of Primary Care Professionals (n = 687)

    CharacteristicsPrimary Care ProviderResidentBehavioral Health ProviderNurseOther Clinical StaffNonclinical StaffAll
    n1675680122108152687
    Age (years), %
        under 250.00.01.35.710.210.55.1
        25 to 3430.985.728.823.037.024.328.8
        35 to 4424.212.536.329.528.723.027.0
        45 to 5418.41.818.818.913.921.118.4
        55 to 6420.20.012.518.910.218.417.1
        65+6.30.02.54.10.02.63.7
    Gender (female), %65.557.181.090.987.891.381.0
    Race (White), %81.473.290.867.266.767.974.8
    Hispanic/Latino, %5.53.65.214.118.626.413.6
    Education (graduate school), %92.410097.512.910.27.947.0
    Years in occupation, mean (standard deviation)13.0 (12.1)1.9 (0.9)7.9 (8.2)12.4 (12.2)8.0 (7.92)7.9 (8.6)10.4 (10.7)
    • View popup
    Table 2.

    Comparison Tests of Burnout Rates Collected Between 2018 and 2019 by Professional Role

    Primary Care ProviderResidentBehavioral Health ProviderNurseOther Clinical StaffNonclinical StaffAllP
    Total burnout (1 or more domains)70%89%59%66%68%70%69%0.014*
    Burnout count<0.001†
    0 domains30%11%41%34%32%31%31%
    1 domain38%26%34%28%39%43%36%
    2 domains24%24%17%25%20%18%21%
    3 domains8%39%8%13%10%9%12%
    • Note: Depersonalization, n = 633; Emotional Exhaustion, n = 685; Personal Accomplishment, n = 634.

    • ↵* Chi-square test was performed comparing groups for dichotomous severity domain scores.

    • ↵† Kruskal–Wallis test was performed comparing groups for continuous domain scores.

    • View popup
    Table 3.

    Comparison Tests of Burnout Domain Scores Collected Between 2018 and 2019 by Professional Role

    Primary Care ProviderResidentBehavioral Health ProviderNurseOther Clinical StaffNonclinical StaffAllP
    Depersonalization<0.001*
    Median (IQR)2 (0 to 5)4.5 (2 to 8)1 (0 to 2)1 (0 to 4)1 (0 to 4)0 (0 to 2)1 (0 to 4)
    Moderate or severe (≥4)34%61%18%29%26%15%28%<0.001†
    Exhaustion*0.002†
    Median (IQR)7 (4 to 10)9 (6 to 12)7 (4 to 11)7 (4 to 12)7 (3 to 11)6 (3 to 9)6 (3 to 9)
    Moderate or severe (≥ 7)56%70%51%52%52%44%52%0.039†
    Personal Accomplishment<0.001*
    Median (IQR)16 (15 to 17)14 (12 to 16)16 (15 to 17)16 (13 to 17)17 (14 to 18)15 (11 to 17)16 (13 to 17)
    Moderate or severe (≤ 14)15%46%21%35%29%46%33%<0.001†
    • Note: Depersonalization, n = 633; Emotional Exhaustion, n = 685; Personal Accomplishment, n = 634.

    • IQR, interquartile range.

    • ↵* Kruskal–Wallis tests were performed comparing groups for continuous domain scores.

    • ↵† Chi-square tests were performed comparing groups for dichotomous severity domain scores.

    • View popup
    Table 4.

    Multivariate Regression Analyses of Burnout Domains Scores Collected 2018 to 2019 by Professional Role with Covariates

    DepersonalizationExhaustionAccomplishment
    B95% CIB95% CIB95% CI
    Resident (base case)0.00—0.00—0.00—
    PCP−1.36*−2.47, −0.26−0.60−2.11, 0.911.21*0.18, 2.25
    BHP−2.73*−3.89, −1.56−0.99−2.59, 0.621.49*0.41, 2.58
    Nurse−1.80*−3.24, −0.36−0.47−2.37, 1.431.47*0.13, 2.81
    Other clinical−2.59*−4.03, −1.16−1.20−3.11, 0.711.93*0.61, 3.26
    Nonclinical−2.98*−4.42, −1.54−2.11*−4.02, −0.200.17−1.16, 1.51
    Constant (intercept)4.13*−2.33, 5.947.85*5.40, 10.3114.56*12.87, 16.23
    Comparison
        PCP vs BHP−1.36*−2.26, −0.47−0.39−1.61, 0.830.28−0.55, 1.11
        vs Other clinical−1.23*−2.37, −0.08−0.60−2.09, 0.890.72−0.34, 1.78
        vs Nonclinical−1.62*−2.73, −0.50−1.52*−3.00, −0.07−1.04*−2.07, −0.01
        Nonclinical vs BHP0.26−1.01, 1.521.13−0.54, 2.801.32*0.15, 2.49
        vs Nurse1.18*0.37, 2.001.64*0.56, 2.731.29*0.54, 2.05
        vs Other clinical0.39−0.43, 1.210.91−0.20, 2.031.76*1.00, 2.52
    • CI, confidence interval.

    • Note: Multivariable regression analyses with practice-level clustering and covariates (race, graduate school, age, years working, training status). Depersonalization, n = 633; Emotional Exhaustion, n = 685; Personal Accomplishment, n = 634. B = unstandardized independent regression coefficient when accounting for all the other variables in the model.

    • BHP, behavioral health provider; PCP, primary care provider.

    • ↵* = P <.05.

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The Journal of the American Board of Family   Medicine: 34 (6)
The Journal of the American Board of Family Medicine
Vol. 34, Issue 6
November/December 2021
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Differences in Occupational Burnout Among Primary Care Professionals
Jessica Clifton, Levi Bonnell, Juvena Hitt, Abigail Crocker, Gail L. Rose, Constance van Eeghen, Rodger Kessler, Kari A. Stephens, Kathryn Teng, Janeen Leon, Brenda Mollis, Benjamin Littenberg
The Journal of the American Board of Family Medicine Nov 2021, 34 (6) 1203-1211; DOI: 10.3122/jabfm.2021.06.210139

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Differences in Occupational Burnout Among Primary Care Professionals
Jessica Clifton, Levi Bonnell, Juvena Hitt, Abigail Crocker, Gail L. Rose, Constance van Eeghen, Rodger Kessler, Kari A. Stephens, Kathryn Teng, Janeen Leon, Brenda Mollis, Benjamin Littenberg
The Journal of the American Board of Family Medicine Nov 2021, 34 (6) 1203-1211; DOI: 10.3122/jabfm.2021.06.210139
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Keywords

  • Cross-Sectional Studies
  • Depersonalization
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  • Occupational Burnout
  • Primary Health Care

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