Lack of Workplace Control Fans the Flames of Doc Burnout

Lack of control over their work environment fostered burnout among physicians, along with an increased desire to bail out of the organization, according to a multi-institutional study.

The analysis of data from 2,339 physicians revealed that those who reported having poor control over their workload had higher levels of burnout (OR 3.83, 95% CI 2.99-4.90), Christine A. Sinsky, MD, of the American Medical Association (AMA) in Chicago, and colleagues reported in the Annals of Internal Medicine.

Besides workload, burnout was independently linked with having poor control over:

• Volume of patient load: OR 1.35 (95% CI 1.04-1.75)
• Choosing members of the clinical team: OR 1.66 (95% CI 1.30-2.12)
• Clinical schedule: OR 1.32 (95% CI 1.01-1.74)
• Domains for which they were accountable: OR 1.26 (95% CI 1.00-1.59)

Sinsky’s group also reported that physicians’ intentions to reduce clinical hours was independently associated with poor control over volume of patient load (OR 1.61, 95% CI 1.21-2.13) and workload (OR 1.40, 95% CI 1.07-1.83).

And a physician’s intention to leave their current position was independently tied to poor influence over staff hiring (OR 1.61, 95% CI 1.18-2.19), and poor control over the domains for which they were accountable (OR 1.40, 95% CI 1.05-1.87), as well as poor control over the workload (OR 1.41, 95% CI 1.03-1.93).

“These details may inform leaders’ thinking about specific dimensions of work control amenable to interventions aimed at reducing physician burnout and intent to reduce clinical effort or leave the organization,” Sinsky and colleagues wrote.

The cross-sectional study had limitations, most notably the inability to identify causation due to the design. The authors also said that the results may not be representative of all U.S. physicians since they used a convenience sample of practices with more than 100 physicians.

And in general, physicians were satisfied with their work environment, as 74.6% reported adequate control over their clinical schedule; 61.4% reported adequate control over patient load; 60.6% reported adequate control over the makeup of their clinical team; and 61.3% reported adequate control over their workload.

Still, the authors pointed out that “[p]hysician control and influence over their immediate care environment has declined over the last several decades,” for a variety of reasons including “the application of an industrial approach favoring standardization over customization,” and the “transfer of work … previously performed by other members of the healthcare team” with electronic health record systems.

Jessi Gold, MD, MS, is the author of a book about the personal effects of physician burnout. Gold, a MedPage Today editorial board member, explained that “many of us [doctors] think that work is going to be me taking care of patients and making them feel better. And so much of the work is paperwork, other people telling you how many patients to see. Burnout comes from that disconnect between what you think work should be and what work actually is.”

Gold, who is the chief wellness officer at the University of Tennessee Health Science Center in Memphis, noted that while physicians may consider leaving their positions, others will stay, but become more detached from work. She also noted that the sense of a loss of control in the workplace has likely spurred union efforts among physicians, such as at Mass General Brigham in Boston and two hospitals in Washington state. The desire to unionize may well be “because people don’t know what else to do when their workplaces and the systems” don’t seem to be listening to their concerns, she added.

Sinksy and colleagues used data on work-control items from the survey-based, nationwide AMA Organizational Biopsy. The survey was sent out to 19 organizations between November 2022 and December 2023, including 14 non-academic medical centers and 16 non-safety-net organizations. To assess burnout, survey respondents were asked to rate how they felt about their level of control over different variables of work, such as the volume of patient load or their influence over staff hires. The response rate for the main survey was about 48%; more than half of respondents were male; most were white; and the majority reported working full-time clinically.

The authors used the Mini-Z Assessment — a measure of emotional exhaustion — asking physicians to choose among five responses that ranged from “I enjoy my work. I have no symptoms of burnout” to “I feel completely burned out. I am at a point where I may need to seek help.”

A physician’s intention to reduce clinical hours, or leave their current position, was based on a rating of their likelihood of either occurrence, ranging from “none” to “definitely.”

The authors offered some feedback on how employers could help reduce burnout, citing a 2023 survey of healthcare executives, which demonstrated that “recruitment and retention of the physician workforce was designated as a top priority,” so “increasing physician control or influence over specific aspects of their clinical work environment” could improve physician retention.

Sinsky’s group acknowledged that giving physicians more control may seem at odds with an organization’s desire to “standardize practice operations,” but they emphasized that it is “imperative … that organizations find the right balance between standardization and customization/flexibility,” particularly in light of a 2023 federal report that projected a nationwide shortage of 140,000 physicians by 2036.

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