• Annals of Family Medicine

    Study Suggests Link Between FP Scope of Practice, Burnout

    June 27, 2018, 10:24 am Sheri Porter – Research findings published in the May/June Annals of Family Medicine suggest family physicians who practice a broader scope of practice early in their careers may be less likely to experience burnout.

    physician reading paper

    Authors of the study titled "Burnout and Scope of Practice in New Family Physicians" noted the particular protective benefits afforded to family physicians who practice inpatient medicine, provide obstetrical care and offer home visits to patients.

    Two researchers involved in the study, lead author Lars Peterson, M.D., Ph.D., research director at the American Board of Family Medicine (ABFM) in Lexington, Ky., and Amanda Weidner, M.P.H., a research scientist at the University of Washington Family Medicine Residency Network in Seattle, corresponded with AAFP News about the study.

    Both agreed that the main finding was somewhat unexpected.

    "Before we began the study, I argued that the association of a broader scope of practice and burnout could go either way," said Peterson.

    "Given our past findings that early-career family physicians were more likely to be burned out, I thought the stress of starting a career and adapting to independent practice would lead to higher burnout in those who were doing more. I was a little surprised we found the opposite."

    Weidner added, "We weren't sure which way the association might go and were pleasantly surprised with our findings." 


    Timely, Important Topic

    The authors noted the timeliness of the study, given the increasing focus on burnout among U.S. physicians.

    "Burnout is being recognized as a major problem in medicine -- with physicians more likely to suffer burnout than the general public," said Peterson. "And the prevalence increasing."

    Peterson pointed out that the problem "is not evenly distributed among physician specialties, and family physicians have one of the higher rates." Early-career family physicians have even more distressing rates than their colleagues who have been in practice for longer periods of time.

    Weidner noted that the research team benefited from the ABFM's relatively new National Family Medicine Graduate Survey, as well as from the type of information gathered by the ABFM in conjunction with its certification/recertification processes.

    "Until recently, we didn't have a whole lot of national data about burnout in family physicians -- and we lacked the ability to compare to other variables," said Weidner.

    Family physicians of all ages should appreciate the importance of the research findings as they relate to individual physicians, as well as to the overall health care system that constantly seeks opportunities to improve patient care and lower costs.

    "This research combines two streams of work the ABFM research team has been interested in," according to Peterson: documentation of the the narrowing of FPs' scope of practice and the knowledge that comprehensive scope is a core aspect of primary care medicine.

    "Given Barbara Starfield's work showing that stronger primary care is associated with better health, higher quality and lower costs, the erosion of family physician scope of practice is a major concern," he added.

    Study Methods

    As noted by Weidner, researchers had access to data from the initial cohort of the National Family Medicine Graduate Survey that the ABFM administered in 2016 to all physicians who graduated from family medicine residency programs in 2013.

    The research team limited its physician sample to those who provided outpatient continuity care, therefore excluding physicians who practiced in the areas of emergency medicine, sports medicine and urgent care, as well as those serving as hospitalists.

    "Our main outcome was self-reported burnout," wrote the authors. "We used a validated single item to measure the emotional exhaustion domain of burnout that correlates highly to this subscale of the Maslach Burnout Inventory."  

    Survey respondents who said they felt burned out from work at least once a week were characterized as "feeling burned out."

    The final sample used for the research included 1,617 physicians with a mean age of 35.9 years; of those

    • 58.6 percent were female,
    • 84.7 percent had an M.D. degree and
    • 66.8 percent graduated from a U.S. medical school.

    A total of 41.9 percent of the sample group said they felt burned out from work at least once a week.

    Additional Highlight

    When comparing the physicians who reported feeling burned out with those who did not, authors found no association with

    • the number of patient encounters per day (20.2 percent versus 20.3 percent, respectively)
    • taking after-hours call (74.2 percent for both groups) or
    • seeing patients on weekends/evenings (53.5 percent versus 51.3 percent).

    The authors noted that family physicians who practiced in more locations and performed a greater variety of procedures/clinical areas were less likely to report feeling burned out.

    "The strongest associations were for practicing obstetrics and inpatient medicine, both areas with a decline in practice among family physician in recent years," wrote the authors.

    Specifically, FPs practicing obstetrics had 36 percent lower odds of feeling burned out, and those practicing inpatient medicine had 30 percent lower odds of burnout when compared to peers not providing those services.

    Weidner stressed, however, that "forcing all family physicians to practice obstetrics and inpatient medicine is not the take-home message of this study."

    "Instead, a main message is that health systems should make sure these sorts of jobs are available for family physicians who desire to practice the broad scope of care for which they have the training, and that these jobs have enough flexibility and reasonable work effort expectations that they are doable," she said.

    Furthermore, "Given that studies have shown that physician burnout is extremely costly to health systems -- and that comprehensiveness is associated with reduced costs -- offering jobs that have flexibility in what is included in the physician's set of clinical duties seems to be in everyone's best interest," said Weidner.

    Peterson added that the idea he'd most like family physicians to take away from this particular study is that "practicing more broadly may actually increase the potential for joy in practice."

    Overall, Peterson and the research team concluded that "promoting a broad scope of practice in primary care, and family medicine in particular, may advance efforts to achieve the quadruple aim" -- a national health care goal of better patient health, better health care delivery, lower costs and higher physician job satisfaction.