A recent study published in JAMA Network Open examined the prevalence of burnout among physicians, the degree of their professional fulfillment, and factors influencing their intention to leave their institution or profession.
Studie: Wohlbefindensparameter und Absicht, die derzeitige Institution unter akademischen Ärzten zu verlassen. Bildquelle: Robert Kneschke / Shutterstock.com
Recent surveys indicate that 6–7% of American physicians leave their practices each year, with this turnover rate continuing to rise. These departures result in disruptions in professional and therapeutic relationships and can impact performance within the institution while increasing the burden on other providers.
Physicians leaving the profession also contribute to shortages in the field, as turnover rates vary by specialty. An imbalance between work and personal life is a strong indicator of burnout, which is associated with high physician turnover.
Physicians perceiving a mismatch between effort and reward in their profession are more likely to leave, as are those reporting intention to leave. Little is known about other factors contributing to turnover and intention to leave, or how intention to leave differs across specialties besides burnout.
In the current cross-sectional study, researchers used data collected from physicians in 15 organizations by the Healthcare Professional Well-being Academic Consortium (PWAC). The survey, conducted from October 2019 to July 2023, asked respondents questions about burnout, professional fulfillment, and contributing factors. While demographic information was included in the data, it was anonymized to protect participants‘ privacy.
Following the principle of reciprocal determinism in social cognitive theory, a clinician’s well-being is achieved through a combination of individual factors, work efficiency, and cultural determinants. The survey encompassed these dimensions through measures such as supportive leadership, control over schedule, alignment of personal and organizational values, perceived meaningfulness of work, impact of work on nonwork relationships, peer support, and mental health, including anxiety, sleep disturbance, and depression. Professional fulfillment was assessed using the Professional Fulfillment Index (PFI), which was the primary outcome measure.
The dataset was analyzed using multivariate logistic regression models that predicted intention to leave based on professional fulfillment and burnout, adjusted for gender, subspecialty, age, ethnic identity, and race. A subsequent analysis explored the relationships between intention to leave and physician well-being determinants.
Of the 37,511 specialty physicians who participated in the survey, 18,719 physicians from 53 medical specialties were included in the analysis as they responded to questions related to at least one of the study outcome measures. In this group, 44.8% were men and 42.9% were women, with 56.6% being White and 12.8% Asian.
Among the 15,890 respondents who answered questions about intention to leave, nearly one-third indicated a medium or higher value of three or more on the Likert scale. Men reported this intention more frequently than women, at 33% and 31.2%, respectively, while Asian and White physicians were less likely to indicate higher intention to leave at 28.9% and 31.2% as compared to physicians of other races at 38.9%.
Respondents aged 60 and above had the highest likelihood of indicating intention to leave at 40.1%. Specialty fields with high intention to leave rates included Anesthesiology, Gastroenterology, Thoracic Surgery, Neurological Surgery, Critical Care, and Radiology. In comparison, areas such as Pediatric Hospital Medicine, Hospice and Palliative Medicine, Neuroradiology, Physical Medicine and Rehabilitation, and Nuclear Medicine had the lowest rates.
Women were more likely than men to report burnout at 42.2% compared to 33%, and less likely to report professional fulfillment at 34.1% compared to 45.4%. Burnout was lowest among respondents aged over 60 at 23.2%, while almost half of physicians in this age group reported high professional fulfillment at 49.5%. Non-White and non-Asian physicians reported the highest burnout and lowest professional fulfillment.
Multivariate regression models showed that after accounting for medical specialties and demographic factors, the risk of intention to leave increased by 52% with each point increase in burnout score. However, the likelihood of intention to leave decreased by 36% with each point increase in professional fulfillment.
When considering burnout, professional fulfillment, and demographic characteristics, factors such as supportive leadership, alignment of personal and organizational values, perceived gratitude, and organizational support related to the Coronavirus Disease 2019 (COVID-19) were associated with reduced risk of intention to leave. However, measures associated with increased intention to leave included depression and negative impact of work on nonwork relationships.
Intention to leave and burnout are widespread among physicians and differ by gender, age, race, and specialty. The novel insights from the current study can be used to inform initiatives that provide better support for physicians specializing in emergency medicine and other frontline specialties likely to experience significant shortages in the future.
- Ligibel, JA, Goularte, N., Berliner, JI, et al. (2023). Wohlbefindensparameter und Absicht, die derzeitige Institution unter akademischen Ärzten zu verlassen. JAMA-Netzwerk geöffnet (2023). doi:10.1001/jamanetworkopen.2023.47894