Burnout: Are Smaller Independent Practices More Happy?

A poll surveying upwards of 15,000 physicians across 29 specialties and found that 42% reported feelings of burnout. Specialties among the highest levels of burnout were within primary care and family medicine at 47%; gynecology and obstetrics at 46%; and internal medicine at 46%. Do these stats mean choosing to practice primary care will increase likelihood of burnout? Not exactly it doesn’t, especially if you work in a small independent practice.

NYU School of Medicine researchers examined levels of burnout among 235 physicians practising in 174 small independent primary care practices and published their findings in the Journal of the American Board of Family Medicine.

The researchers found among the 235 physicians there was an incredibly low level of burnout at a mere 13.5% compared to the national average of 54.4%. To find out why the researchers had to go back to the qualitative data.

When the team sat with their subjects they found many of the physicians had the same complaints as their non-independent counterparts such as reimbursement rates and electronic health records. One would think the combined complaints and addition of running their own practice would lead to additional stress and burnout, but this is not the case; whatever control they have over their practice as a result of being independent somehow seems to relate to the low burnout rate.

Participating physicians valued the autonomy they have as independents, and ability it allows them to practice medicine they way they want, when they want, and where they wanted. Many were immigrants practicing in communities in which they lived, speaking more than one language and had attracted many bilingual patients. These physicians were committed to their communities and were the kind of old fashioned doctors who patients see from the cradle to the grave; many had taken care of generations of the same family, which is fulfilling, explains Donna Shelley, M.D.

It was noted that the small independent primary care practices were well supported by city health departments, which could potentially have helped to lower their burnout rates as the city health department identified them as serving a large number of Medicaid patients and underserved population, and had been helping them with electronic health records and quality improvements.

The healthcare industry should look at the happier sites to find what the secret spice is, and what it is about the smaller independent practices that promotes lower burnout rates even though they are also under stress of challenging environments, have reimbursement and financial issues, and use of electronic health records, yet still seem to be happier.

Shelley suggests the healthcare system should start by finding ways to give physicians a greater sense of autonomy such as small amounts of money to clinicians to innovate in an area where they see a need for change, which should improve burnout rate by being given funds and space to act autonomously and make changes.

Practicing as an independent physician is by far without stresses, and not all are well funded by city health departments providing them with support, but this doesn’t mean that they are on their own. The Association of Independent Doctors and other associations are working towards educating patients, insurance providers, and the government about the importance of independent physicians as well as looking out for their best interest.

AID was founded in 2013 and has 5 mission statements including promoting transparency in pricing, working with insurance companies, stopping consolidation of hospitals and medical groups, educating patients, and helping doctors to remain independent; and they agree with Shelley’s hypothesis of greater autonomy could reduce physician burnout rates.

Doctors working autonomously in smaller practices have a say in how things are run and they can be the decision makers. Most doctors are naturally gifted and pretty sharp, they want to have a say in how their day goes and how the practice is run; if that means they can only see 15 patients a day rather than 35 in order to do a great job they get to make that call.

One of the common complaints heard was that doctors would be happier if they could restore the integrity of the patient doctor relationship that seems to be getting stripped away. Most doctors go into medicine because they want to help people, that’s their mission, they want it to be about caring about the patient. Many say that hospitals and the government don’t care, they are just looking to make money, most doctors don’t want to be exploited this way. Most doctors don’t want medicine and healthcare to be about making money off of their backs, however, unfortunately that is exactly what is happening.