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. 2023 May;38(7):1689-1696.
doi: 10.1007/s11606-023-08034-5. Epub 2023 Jan 25.

Patient Enrollment Growth and Burnout in Primary Care at the Veterans Health Administration

Allyson W O'Connor  1 , Edwin S Wong  2   3 , Karin M Nelson  3   4 , Jeanne M Sears  2   5   6   7 , Christian D Helfrich  2   3
Affiliations

Patient Enrollment Growth and Burnout in Primary Care at the Veterans Health Administration

Allyson W O'Connor et al. J Gen Intern Med. 2023 May.

Abstract

Background: Patient enrollment levels at Veterans Health Administration (VHA) facilities change based on Veteran demand for care, potentially affecting demands on staff. Effects on burnout in the primary care workforce associated with increases or decreases in enrollment are unknown.

Objective: Estimate associations between patient enrollment and burnout.

Design: In this serial cross-sectional study, VHA patient enrollment and workforce data from 2014 to 2018 were linked to burnout estimates for 138 VHA facilities. The VHA's annual All Employee Survey provided burnout estimates.

Participants: A total of 82,421 responses to the 2014-2018 All Employee Surveys by primary care providers (PCPs), including physicians, nurse practitioners, and physician assistants; nurses; clinical associates; and administrative clerks were included. Respondents identified as patient-aligned care team members.

Main measures: Independent variables were (1) the ratio of enrollment to PCPs at VHA facilities and (2) the year-over-year change in enrollment per PCP. Burnout was measured as the annual proportion of staff at VHA facilities who reported emotional exhaustion and/or depersonalization. Each primary care role was analyzed independently.

Key results: Overall enrollment decreased from 1553 enrollees per PCP in 2014 to 1442 enrollees per PCP in 2018 across VHA facilities. Forty-three facilities experienced increased enrollment (mean of 1524 enrollees/PCP in 2014 to 1668 in 2018) and 95 facilities experienced decreased enrollment (mean of 1566 enrollees/PCP in 2014 to 1339 in 2018). Burnout decreased for all primary care roles. PCP burnout was highest, decreasing from a facility-level mean of 51.7% in 2014 to 43.8% in 2018. Enrollment was not significantly associated with burnout for any role except nurses, for whom a 1% year-over-year increase in enrollment was associated with a 0.2 percentage point increase in burnout (95% CI: 0.1 to 0.3).

Conclusions: Studies assessing changes in organizational-level predictors are rare in burnout research. Patient enrollment predicted burnout only among nurses in primary care.

Keywords: burnout; healthcare; patient panel; primary care; workload.

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Conflict of interest statement

The authors have no conflicts of interest to disclose in relation to this work.

Figures

Figure 1
Figure 1
Trends in burnout for VHA facilities from 2014 to 2018. Trend lines estimate the mean proportion of employees at VHA facilities who report burnout by year and primary care role with 95 CIs. PCP, primary care provider.
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References

    1. Felton JS. Burnout as a clinical entity - its importance in health care workers. Occup Med (Chic Ill). 1998;48(4):237-250. 10.1093/occmed/48.4.237. - PubMed
    1. Portoghese I, Galletta M, Coppola RC, Finco G, Campagna M. Burnout and workload among health care workers: the moderating role of job control. Saf Health Work. 2014;5(3):152-157. 10.1016/j.shaw.2014.05.004. - PMC - PubMed
    1. Reith TP. Burnout in United States Healthcare Professionals: A Narrative Review. Cureus. 2018;10(12). 10.7759/cureus.3681. - PMC - PubMed
    1. Shanafelt TD, Boone S, Tan L, et al. Burnout and satisfaction with work-life balance among US physicians relative to the general US population. Arch Intern Med. 2012;172(18):1377-1385. 10.1001/archinternmed.2012.3199. - PubMed
    1. Cordes CL, Dougherty TW. A Review and an Integration of Research on Job Burnout. Acad Manag Rev. 1993;18(4):621-656. 10.5465/amr.1993.9402210153.

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