Longitudinal Study Evaluating the Association Between Physician Burnout and Changes in Professional Work Effort

doi:10.1016/j.mayocp.2016.02.001

Mayo Clinic Proceedings

Volume 91, Issue 4, April 2016, Pages 422-431

https://doi.org/10.1016/j.mayocp.2016.02.001 Get rights and content

Abstract

Objective

To longitudinally evaluate the relationship between burnout and professional satisfaction with changes in physicians' professional effort.

Participants and Methods

Administrative/payroll records were used to longitudinally evaluate the professional work effort of faculty physicians working for Mayo Clinic from October 1, 2008, to October 1, 2014. Professional effort was measured in full-time equivalent (FTE) units. Physicians were longitudinally surveyed in October 2011 and October 2013 with standardized tools to assess burnout and satisfaction.

Results

Between 2008 and 2014, the proportion of physicians working less than full-time at our organization increased from 13.5% to 16.0% (P=.05). Of the 2663 physicians surveyed in 2011 and 2776 physicians surveyed in 2013, 1856 (69.7%) and 2132 (76.9%), respectively, returned surveys. Burnout and satisfaction scores in 2011 correlated with actual reductions in FTE over the following 24 months as independently measured by administrative/payroll records. After controlling for age, sex, site, and specialty, each 1-point increase in the 7-point emotional exhaustion scale was associated with a greater likelihood of reducing FTE (odds ratio [OR], 1.43; 95% CI, 1.23-1.67; P<.001) over the following 24 months, and each 1-point decrease in the 5-point satisfaction score was associated with greater likelihood of reducing FTE (OR, 1.34; 95% CI, 1.03-1.74; P=.03). On longitudinal analysis at the individual physician level, each 1-point increase in emotional exhaustion (OR, 1.28; 95% CI, 1.05-1.55; P=.01) or 1-point decrease in satisfaction (OR, 1.67; 95% CI, 1.19-2.35; P=.003) between 2011 and 2013 was associated with a greater likelihood of reducing FTE over the following 12 months.

Conclusion

Among physicians in a large health care organization, burnout and declining satisfaction were strongly associated with actual reductions in professional work effort over the following 24 months.

Section snippets

Demographic Characteristics and Professional Effort

Mayo Clinic is a nonprofit, physician-led health care organization with 3 large academic campuses (Rochester, Minnesota; Scottsdale, Arizona; and Jacksonville, Florida) as well as an integrated group of community-based hospitals and health care facilities. The professional effort of physicians at Mayo Clinic is measured as a fraction of full-time equivalent (FTE) units. For example, an FTE of 1.0 indicates a physician working full-time, and an FTE of 0.5 indicates a physician working half-time.

Changes in Professional Effort of Physicians Over Time

Complete data on the percentage of physicians working less than full-time were available for all physicians working at Mayo Clinic from October 1, 2008, to October 1, 2014. The proportion of physicians working less than full-time on October 1 of each year according to Mayo Clinic Human Resources employment records is provided in Table 1 (see Supplemental Tables 1 and 2 for additional details, available online at http://www.mayoclinicproceedings.org). The proportion of physicians working less

Discussion

In this prospective study of physicians, burnout and satisfaction were related to future reductions in professional work hours as assessed by administrative/payroll records. Specifically, physicians with greater degrees of emotional exhaustion in 2011 were more likely to reduce their FTE over the following 24 months. Physicians with lower degrees of satisfaction were also more likely to reduce their FTE over the following 24 months. The relationship between emotional exhaustion and satisfaction

Conclusion

Among the physicians in a large health care organization, measures of burnout and satisfaction were strongly associated with subsequent reductions in work effort as measured by independent employment records over the following 24 months. Further research is needed to understand whether these factors are causal and whether modifications to the practice environment aimed at reducing burnout and improving satisfaction would modify this relationship.

Acknowledgments

Dr Reeves had full access to all the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis.

References (46)

T.D. Shanafelt et al.
Changes in burnout and satisfaction with work-life balance in physicians and the general US working population between 2011 and 2014
Mayo Clin Proc
(2015)
T. Shanafelt et al.
Why do surgeons consider leaving practice [letter]?
J Am Coll Surg
(2011)
Y. Zhang et al.
The relationship between job satisfaction, burnout, and turnover intention among physicians from urban state-owned medical institutions in Hubei, China: a cross-sectional study
BMC Health Serv Res
(2011)
L.N. Dyrbye et al.
Physician satisfaction and burnout at different career stages
Mayo Clin Proc
(2013)
J.E. McMurray et al.
Part-time medical practice: where is it headed?
Am J Med
(2005)
T.D. Shanafelt et al.
The well-being of physicians
Am J Med
(2003)
C.M. Balch et al.
Surgeon distress as calibrated by hours worked and nights on call
J Am Coll Surg
(2010)
T.D. Shanafelt et al.
Impact of organizational leadership on physician burnout and satisfaction
Mayo Clin Proc
(2015)
D.A. Asch et al.
Response rates to mail surveys published in medical journals
J Clin Epidemiol
(1997)
Association of American Medical Colleges. The Complexities of Physician Supply and Demand: Projections from 2013 to...

US Department of Health and Human Services. The Physician Workforce: Projections and Research into Current Issues...

C. Bressi et al.

Haemato-oncology and burnout: an Italian survey

Br J Cancer

(2008)

T.D. Shanafelt et al.

Physician burnout: an urgent call for early intervention—reply

JAMA Intern Med

(2013)

T.D. Shanafelt et al.

Satisfaction with work-life balance and the career and retirement plans of US oncologists

J Clin Oncol

(2014)

E.S. Williams et al.

Understanding physicians' intentions to withdraw from practice: the role of job satisfaction, job stress, mental and physical health

Health Care Manage Rev

(2010)

C.S. Dewa et al.

How does burnout affect physician productivity? a systematic literature review

BMC Health Serv Res

(2014)

B.E. Landon et al.

Leaving medicine: the consequences of physician dissatisfaction

Med Care

(2006)

B. Sibbald et al.

National survey of job satisfaction and retirement intentions among general practitioners in England

BMJ

(2003)

C.S. Dewa et al.

An estimate of the cost of burnout on early retirement and reduction in clinical hours of practicing physicians in Canada

BMC Health Serv Res

(2014)

C. Maslach et al.

Maslach Burnout Inventory Manual

(1996)

T.D. Shanafelt et al.

Burnout and satisfaction with work-life balance among US physicians relative to the general US population

Arch Intern Med

(2012)

T.D. Shanafelt et al.

An interactive individualized intervention to promote behavioral change to increase personal well-being in US surgeons

Ann Surg

(2014)

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View all citing articles on Scopus

: For editorial comment, see page 408

: Grant Support: Funding for this study was provided by the Mayo Clinic Office of Organization and Leadership Development and the Mayo Clinic Department of Internal Medicine Program on Physician Well-being.

View full text

Original articleLongitudinal Study Evaluating the Association Between Physician Burnout and Changes in Professional Work Effort

Abstract

Objective

Participants and Methods

Results

Conclusion

Section snippets

Demographic Characteristics and Professional Effort

Changes in Professional Effort of Physicians Over Time

Discussion

Conclusion

Acknowledgments

Mayo Clin Proc

J Am Coll Surg

BMC Health Serv Res

Mayo Clin Proc

Am J Med

Am J Med

J Am Coll Surg

Mayo Clin Proc

J Clin Epidemiol

Haemato-oncology and burnout: an Italian survey

Br J Cancer

Physician burnout: an urgent call for early intervention—reply

JAMA Intern Med

Satisfaction with work-life balance and the career and retirement plans of US oncologists

J Clin Oncol

Understanding physicians' intentions to withdraw from practice: the role of job satisfaction, job stress, mental and physical health

Health Care Manage Rev

How does burnout affect physician productivity? a systematic literature review

BMC Health Serv Res

Leaving medicine: the consequences of physician dissatisfaction

Med Care

National survey of job satisfaction and retirement intentions among general practitioners in England

BMJ

An estimate of the cost of burnout on early retirement and reduction in clinical hours of practicing physicians in Canada

BMC Health Serv Res

Maslach Burnout Inventory Manual

Burnout and satisfaction with work-life balance among US physicians relative to the general US population

Arch Intern Med

An interactive individualized intervention to promote behavioral change to increase personal well-being in US surgeons

Ann Surg

Original article
Longitudinal Study Evaluating the Association Between Physician Burnout and Changes in Professional Work Effort