Study reveals burnout and professional dissatisfaction driving physicians to leave their practices

By Priyanjana Pramanik, MSc.Reviewed by Benedette Cuffari, M.Sc.Jan 1 2024

A recent study published in JAMA Network Open explores the prevalence of burnout among physicians, their levels of professional fulfillment, and factors impacting their intention to leave (ITL) their institution or profession.

Study: Well-being parameters and intention to leave current institution among academic physicians. Image Credit: Robert Kneschke / Shutterstock.com

Background

Recent surveys suggest that 6-7% of American physicians leave their practices each year, with this turnover rate continuing to rise. These departures lead to interruptions in professional and therapeutic relationships and may disrupt the delivery of care within the institution while also increasing the burden on other providers.

Physicians leaving medicine also contributes to shortages in the field, with attrition rates differing between specialties. Work-life imbalance strongly predicts burnout, which is associated with high physician turnover.

Physicians who perceive a mismatch between effort and reward in their professions are likelier to leave their profession, as are those who report ITL. Little is known about factors other than burnout that may contribute to turnover and ITL or how ITL differs between specialties.

About the study

In the current cross-sectional study, researchers used data collected by the Healthcare Professional Well-being Academic Consortium (PWAC) from physicians across 15 organizations. The survey, conducted from October 2019 to July 2023, asked respondents to answer questions regarding burnout, professional fulfillment, and contributing factors. While demographic information was included in the data, it was deidentified to protect the participants' privacy.

According to the principle of reciprocal determinism in social cognitive theory, the well-being of a clinician is achieved by a combination of individual factors, work efficiency, and cultural determinants. The survey included these dimensions by taking measures such as supportive leadership, control over schedule, alignment of personal and organizational values, perceived meaningfulness of work, the effect of work on non-work relationships, peer support, and mental health, including anxiety, sleep impairment, and depression. Work 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 ITL based on professional fulfillment and burnout and adjusted for gender, subspeciality, age, ethnicity, and race. A subsequent analysis assessed the relationships between ITL and determinants of physician well-being.

Study findings

Of the 37,511 attending-level medical specialists who received the survey, 18,719 physicians from across 53 medical specialties were included in the analysis, as they had responded to questions related to at least one of the study outcome measures. In this group, 44.8% were male and 42.9% were female, whereas 56.6% were White and 12.8% were Asian.

Of the 15,890 respondents who answered questions about their ITL, nearly one-third reported a moderate or higher score of three or more on the Likert scale. Men were slightly more likely than women to report this level of ITL at 33% and 31.2%, respectively, while Asian and White physicians were less likely to report greater ITL at 28.9% and 31.2%, respectively than those from other races at 38.9%.

Respondents 60 years and older had the highest probability of reporting ITL at 40.1%. Specialties with high ITL rates included anesthesiology, gastroenterology, thoracic surgery, neurological surgery, critical care, and radiology. Comparatively, pediatric hospital medicine, hospice and palliative care, 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%, respectively, and less likely to report professional fulfillment at 34.1% compared to 45.4%. Burnout was lowest among respondents over the age of 60 at 23.2%, while nearly half of the physicians in this age group reported high levels of professional fulfillment at 49.5%. Non-White and non-Asian physicians were most likely to report burnout and least likely to report professional fulfillment.

The multivariate regression models indicated that, after controlling for medical specialty and demographic factors, ITL risk increased by 52% if the burnout score increased by one point. However, increasing the professional fulfillment score by one point reduced ITL probability by 36%.

Controlling for burnout, professional fulfillment, and demographic characteristics, ITL risk was decreased by factors such as supportive leadership behavior, alignment of personal and organizational values, perceived gratitude, and organizational support related to coronavirus disease 2019 (COVID-19). However, measures that were associated with higher ITL risk included depression and the negative impact of work on non-work relationships.

Conclusions

ITL and burnout are pervasive among physicians and differ by gender, age, race, and specialty. The novel insights from the current study can be used to develop initiatives that provide better support for physicians specializing in emergency medicine and other frontline specialties, which will likely face substantial shortages in the future.