The American Academy of Family Physicians (AAFP) strongly believes that physician burnout is a health system, organization, practice, and physician culture problem, not just an individual concern. Therefore, the AAFP applies a systems-based approach to identifying and addressing root causes of physician burnout at all levels of the family physician ecosystem while promoting practices supportive of physician well-being throughout the family physician career journey.
Physician burnout was present and impacting physicians prior to the COVID-19 pandemic; however, the pandemic and subsequent experiences dropped the percentage of physicians reporting being very or somewhat happy with their jobs from 75% to 48%.1 Family physicians suffer from significantly higher rates of burnout than physicians in many other specialties with 51% of family physicians reporting being burned out in 2022.2 Burnout negatively affects quality of patient care including a two-fold increase in odds for unsafe care, unprofessional behaviors and low patient satisfaction.3 Burnout is driving physicians to reduce or leave clinical practice, thus contributing to the primary care workforce shortage.4
Defining Burnout & Physician Well-being
“[Job burnout is] a psychological syndrome in response to chronic interpersonal stressors on the job. The three key dimensions of this response are overwhelming exhaustion, feelings of cynicism and detachment from the job, and a sense of ineffectiveness and lack of accomplishment."5
The Centers for Disease Control and Prevention (CDC) defines well-being as "In simple terms, well-being can be described as judging life positively and feeling good."6
Drivers of Physician Burnout
The importance of identifying and addressing the root causes of physician burnout cannot be overemphasized. Physician burnout if often an interplay of systemic drivers as a result of healthcare organizations and systems and individual physician level factors. Studies indicate that common drivers of family physician burnout include the following: paperwork; feeling undervalued; frustrations with referral networks; difficult patients; medicolegal issues; and challenges in finding work-life balance.7,8 These factors have varying impact at different stages of a physician’s career.9 Inability to resolve work-life conflict has the greatest impact on physicians early in their careers.8 Long hours, frequent call, frustration with administrative burden, and reimbursement issues strongly affect physicians in the middle of their careers.8
In 2013, the American Medical Association (AMA) commissioned a study by the Rand Corporation to identify high-priority determinants of physician professional satisfaction.12 The authors reported that two important factors influencing professional satisfaction are the use of electronic health records (EHRs) and physicians’ perceptions of their ability to provide high-quality care. Other factors that affect physician professional satisfaction include the following:
Individual physician factors may also impact burnout including gender, age, sexual orientation and race/ethnicity.2,9,10 Discrimination, lack of respect from colleagues and patients due to race/ethnicity and feeling that their opinions are not considered because of their race or ethnicity are experiences that drive to a culture of feeling undervalued by racially and ethnically minoritized and marginalized physicians in the U.S.10 Family physicians who identify as female, especially those younger than 40 years of age, experience burnout at higher rates than males.11 While there are no burnout studies in LGBTQ+ family physicians, in other specialties LGBTQ+ orientation has been identified as a burnout risk factor in part due to workplace discrimination.13
Interventions Supporting Physician Well-being and Professional Satisfaction
Well-being and professional satisfaction are not simply the absence of burnout, just as good health is not simply the absence of disease. Supporting family physicians requires a multi-dimensional approach that includes reduction of burnout drivers in addition to ensuring access to well-being promoting cultures and skills.
Each individual family physician uniquely experiences his or her professional role within the context of many variables. Five influential elements interact to form the family physician ecosystem illustrated in Figure 1.
The variables include:
Interventions to improve personal well-being and professional satisfaction must be customized based on the family physician’s experience of this ecosystem. Historically, most programs to address burnout have focused on the treatment of individual physicians (e.g., counseling services). Studies have found that self-awareness and mindfulness training can reduce physician burnout and increase both physician well-being and patient-centered qualities.14 However, we now know that resilience training without system-level interventions is insufficient. Interventions should be multimodal, include accountability though identification and reporting of institutional success metrics such as physician satisfaction and well-being, and support development of practice models that preserve the decision making autonomy of physicians.15, 16 Additionally, cultures supporting physician well-being should extend into training settings such as medical schools and residency programs ensuring our future family physicians are empowered to identify and advocate for their needs throughout their careers.
Leading Physician Well-being
Physician burnout must be dealt with transparently and proactively because it affects both patient safety and physician well-being. Protecting the family physician workforce to ensure continuous access to high-quality care is critically important. It requires increasing the pathway into family medicine as well as protecting our practicing colleagues allowing them to remain in practice.
All family physicians are leaders and are key influencers of their communities and workplaces. The AAFP will continue to support a systems-based approach that empowers family physicians to identify and address the root causes of burnout while leading the creation of a culture of well-being. As a trusted partner for members interested in developing their personal resilience and systems-based improvement skills, the AAFP is committed to providing education, resources and experiences to support all members’ well-being and professional satisfaction.
(2014 COD) (February 2023 BC)