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. 2024 Nov 4;7(11):e2442687.
doi: 10.1001/jamanetworkopen.2024.42687.

Team and Electronic Health Record Features and Burnout Among Family Physicians

Lisa S Rotenstein  1   2   3 , Nathaniel Hendrix  4 , Robert L Phillips  4 , Julia Adler-Milstein  1
Affiliations

Team and Electronic Health Record Features and Burnout Among Family Physicians

Lisa S Rotenstein et al. JAMA Netw Open. .

Abstract

Importance: In the context of a growing volume of electronic health record (EHR)-based work and post-COVID-19 pandemic staffing pressures, health system leaders need an up-to-date understanding of changes in family physicians' experiences of burnout, determinants of burnout, and how to enhance the family physicians' experience.

Objective: To evaluate the association of family physicians' perceptions of team structure and EHR experiences with burnout and identify modifiable practice structure factors associated with team and EHR experiences.

Design, setting, and participants: A serial cross-sectional survey study was conducted from December 1, 2016, to October 24, 2023. Participants included family physicians seeking continuous certification through the American Board of Family Medicine.

Main outcomes and measures: Yearly prevalence of burnout, perceived team efficiency, perceived EHR proficiency, and perceived EHR time were the outcomes. Multivariable logistic regression models subsequently assessed associations of team- and EHR-related experiences with burnout and the association between practice structure and staffing features in team efficiency and EHR time.

Results: The study included 10 315 physicians who answered the subset of questions related to burnout on the American Board of Family Medicine's Continuous Certification Questionnaire between 2017 and 2023. Among the sample, 5584 respondents (54.1%) were male, and the median age was 50 (IQR, 43-58) years. The proportion of physicians reporting burnout ranged from 37.9% in 2017 to a peak of 42.8% in 2022, which did not represent a significant temporal trend (P = .91). Appropriate home EHR use was associated with 0.58 (95% CI, 0.53-0.64; P < .001) times the odds of burnout, while high team efficiency was associated with 0.61 (95% CI, 0.56-0.67; P < .001) times the odds of burnout. Physician collaboration with a registered nurse was associated with greater odds of high team efficiency (odds ratio [OR], 1.35; 95% CI, 1.22-1.50). Collaboration with a physician assistant was associated with greater odds of appropriate home EHR time (OR, 1.13; 95% CI, 1.03-1.24).

Conclusions and relevance: In this national cross-sectional study of US family physicians, appropriate time spent on the EHR at home and primary care team efficiency were associated with lower odds of burnout. These findings suggest that clinical leaders and policymakers should focus on optimizing primary care team support and family physicians' EHR experiences to enhance the sustainability of primary care practice.

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Conflict of interest statement

Conflict of Interest Disclosures: Dr Rotenstein reported receiving personal fees from Phreesia Inc, receiving stock grants from serving on the advisory board of Augmedix Inc, and grants from the Agency for Healthcare Research and Quality, American Medical Association, Physicians Foundation, and Association of Chiefs and Leaders in General Internal Medicine outside the submitted work. Dr Hendrix reported receiving grants from the Office of the National Coordinator for Health Information Technology during the conduct of the study. Dr Phillips reported receiving a cooperative agreement from the Office of the National Coordinator for Health Information Technology (now Assistant Secretary for Technology Policy/Office of the National Coordinator). Dr Adler-Milstein reported that University of California, San Franciso, has received funding from the Office of the National Coordinator for Health IT to partner with the American Board of Family Medicine to revise the survey over time to better capture interoperability.

Figures

Figure 1.
Figure 1.. Prevalence of Burnout, Perceptions of Team Efficiency, Home Electronic Health Record (EHR) Time, and EHR Proficiency Among Family Physicians by Year
Figure 2.
Figure 2.. Cross-Sectional Adjusted Associations of Team Efficiency, Appropriate Home Electronic Health Record (EHR) Time, and High EHR Proficiency With Burnout
Model was additionally adjusted for respondent age, medical degree type, sex, practice location, practice site type, respondent’s practice ownership status, practice size, practice specialty mix, and year.
Figure 3.
Figure 3.. Organizational Factors Associated With High Team Efficiency, Appropriate Home Electronic Health Record (EHR) Time, and Both Outcomes in Multivariable Logistic Regression Models
In addition to factors presented in the panels, models were additionally adjusted for respondent age, medical degree type, sex, practice specialty mix, and year. FQHC indicates federally qualified health center; HMO, health maintenance organization; MA, medical assistant; PA, physician assistant; RN, registered nurse.
Figure 4.
Figure 4.. Organizational Factors Associated With High Team Efficiency, Appropriate Home Electronic Health Record (EHR) Time, and Both Outcomes in Multivariable Logistic Regression Models
In addition to factors presented in the panels, models were additionally adjusted for respondent age, medical degree type, sex, practice specialty mix, and year. Models were based on 2022-2023 data alone since these were the only years when a question about value-based care participation was asked in the survey. FQHC indicates federally qualified health center; HMO, health maintenance organization; MA, medical assistant; PA, physician assistant; RN, registered nurse.
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Comment in

  • doi: 10.1001/jamanetworkopen.2024.42703

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