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. 2022 Nov 4;3(11):e224163.
doi: 10.1001/jamahealthforum.2022.4163.

Trends in Clinician Burnout With Associated Mitigating and Aggravating Factors During the COVID-19 Pandemic

Mark Linzer  1 , Jill O Jin  2 , Purva Shah  3 , Martin Stillman  1 , Roger Brown  4 , Sara Poplau  1 , Nancy Nankivil  3 , Kyra Cappelucci  3 , Christine A Sinsky  3
Affiliations

Trends in Clinician Burnout With Associated Mitigating and Aggravating Factors During the COVID-19 Pandemic

Mark Linzer et al. JAMA Health Forum. .

Erratum in

  • Error in Abstract.
    [No authors listed] [No authors listed] JAMA Health Forum. 2023 Feb 3;4(2):e230002. doi: 10.1001/jamahealthforum.2023.0002. JAMA Health Forum. 2023. PMID: 36763371 Free PMC article. No abstract available.

Abstract

Importance: The COVID-19 pandemic has affected clinician health and retention.

Objective: To describe trends in burnout from 2019 through 2021 with associated mitigating and aggravating factors.

Design, setting, and participants: Cross-sectional surveys were sent to physicians and advanced practice clinicians throughout 120 large US health care organizations between February 2019 and December 2021. From 56 090 surveys, there were 20 627 respondents.

Exposures: Work conditions and COVID-19.

Main outcomes and measures: Surveys measured time pressure, chaos, work control, teamwork, electronic health record use, values alignment, satisfaction, burnout, intent to leave, and in 2021, feeling valued. Multivariate regressions controlling for gender, race and ethnicity, years in practice, and role determined burnout, satisfaction, and intent-to-leave correlates.

Results: Of the 20 627 respondents (median response rate, 58% [IQR, 34%-86%; difference, 52%]), 67% were physicians, 51% female, and 66% White. Burnout was 45% in 2019, 40% to 45% in early 2020, 50% in late 2020, and 60% in late 2021. Intent to leave increased from 24% in 2019 to more than 40% as job satisfaction decreased. Higher burnout was seen in chaotic workplaces (odds ratio [OR], 1.51; 95% CI, 1.38-1.66; P < .001) and with low work control (OR, 2.10; 95% CI, 1.91-2.30; P < .001). Higher burnout was associated with poor teamwork (OR, 2.08; 95% CI, 1.78-2.43; P < .001), while feeling valued was associated with lower burnout (OR, 0.22; 95% CI, 0.18-0.27; P < .001). In time trends, burnout was consistently higher with chaos and poor work control. For example, in the fourth quarter of 2021 burnout was 36% (95% CI, 31%-42%) in calm environments vs 78% (95% CI, 73%-84%) if chaotic (absolute difference, 42%; 95% CI, 34%-49%; P < .001), and 39% (95% CI, 33%-44%) with good work control vs 75% (95% CI, 69%-81%) if poor (absolute difference, 36%; 95% CI, 27%-44%; P < .001). Good teamwork was associated with lower burnout rates (49%; 95% CI, 44%-54%) vs poor teamwork (88%; 95% CI, 80%-97%; absolute difference, 39%; 95% CI, 29%-48%; P < .001), as was feeling valued (37%; 95% CI, 31%-44%) vs not feeling valued (69%; 95% CI, 63%-74%; absolute difference, 32%; 95% CI, 22%-39%; P < .001).

Conclusions and relevance: Results of this survey study show that in 2020 through 2021, burnout and intent to leave gradually increased, rose sharply in late 2021, and varied by chaos, work control, teamwork, and feeling valued. Monitoring these variables could provide mechanisms for worker protection.

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Conflict of interest statement

Conflict of Interest Disclosures: Dr Linzer reported grants from the American Medical Association during the conduct of the study, as well as grants from the National Institutes of Health and the Agency for Healthcare Research and Quality, and other support through his employer from the American College of Physicians, the Optum Office for Provider Advancement, the Institute for Healthcare Improvement, the American Board of Internal Medicine, Essentia Health, Gillette Children’s Specialty Healthcare, and the California Area Health Education Center outside the submitted work; he consults for Harvard University on a grant assessing work conditions and diagnostic accuracy. Dr Jin reported support from the American Medical Association as a physician adviser for work on physician burnout during the conduct of the study. Dr Stillman reported support from the American Medical Association during the conduct of the study, as well as grants from Optum, Essentia Health, and Gillette Children’s Specialty Healthcare through Hennepin Healthcare outside the submitted work. Dr Brown reported personal fees from the American Medical Association during the conduct of the study. Ms Poplau reported support from the American Medical Association during the conduct of the study, as well as grants from the American College of Physicians, Gillette Children’s Specialty Healthcare, Essentia Health, the Institute for Healthcare Improvement, Optum, and the California Area Health Education Center through Hennepin Healthcare outside the submitted work. No other disclosures were reported.

Figures

Figure 1.
Figure 1.. Trends in Clinician Burnout, 2019-2021
Lines represent simple linear functions to the data, dots represent the average proportional values per time period, and whiskers represent 95% CIs around the average proportional values.
Figure 2.
Figure 2.. Variation in Burnout Trends by Key Aggravators and Mitigators
Lines represent simple linear functions to the data, dots represent the average proportional values per time period, and whiskers represent 95% CIs around the average proportional values.
See this image and copyright information in PMC

Comment in

References

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