Interim Physicians Blog

Dr. Ken's Corner: Why Do Small, Independent Practices Have Less Burnout?

Posted by Ken Teufel M.D. on Nov 1, 2018 12:09:36 PM

Telling burned out physicians they need to learn how to cope better with stress is not working. Despite numerous programs designed to improve physician "resilience," the rate of physician burnout keeps climbing. With overall burnout estimates ranging from 30% to 68%, a recent study reveals that there's one subset of physicians with a rate of only 13.5% -- primary care physicians in solo or small practices (Journal American Board of Family Medicine, July-August 2018).

Previous studies of physician burnout rates have focused almost exclusively on larger practices. NYU's Dr. Donna Shelley led the study that corrects this oversight by looking at burnout rates in small independent primary care practices (SIPs), practices with no more than five physicians. Approximately 70% of the 235 physicians surveyed were in solo practice.

37952168_s"Compared with the burnout rate among physicians in previous studies," says Dr. Shelley, "we found a remarkably low burnout rate" of  13.5%. Dr. Shelley concludes that "one explanation for this finding could be the autonomy (i.e., control of the work environment) associated with owning one's own practice as opposed to working in an integrated health system or federally qualified health center where providers are subject to greater regulations." Another possible reason: "Compared with larger practices, SIPs may have deeper relationships with their patients, which may lead to greater job satisfaction and less burnout among providers."

Even when they're aware of the tradeoff, the question many physicians are asking: "Should I follow my colleagues into the large group or remain independent?" Apparently the biggest benefit of being part of a larger practice is the leverage a doctor has when negotiating third-party payment contracts. With today's less personal, more business-focused environment, "medicine has become all about the almighty dollar and nothing about the care of patients," says an internist interviewed for a medscape.com article entitled "Is Physician Autonomy Dead?"

What's needed is a renewed sense of community among physicians, says Dr. Tait Shanafelt, Chief Wellness Officer at Stanford Health Care (The Wall Street Journal, June 9, 2018). "We are interacting with our patients less. We are interacting with our colleagues less. We are becoming more isolated," says Dr. Shanafelt. Echoing this sentiment is Steve Corso, Irving [Texas]-based MedSynergies' managing director of physician engagement (dmagazine.com). As large health systems try to absorb newly acquired physicians, he says little attention is being paid to maintaining physician autonomy in the process. "Older agreements included physician autonomy," says Corso. "The reality now is that physician acquisition means centralization, and that's not autonomy. Losing autonomy is the root cause of anxiety for physicians." Thoracic surgeon Dr. John J. Squires adds that "healthcare organizations are failing to change the system that is increasingly asking doctors to perform tasks, largely administrative, for which they have no passion" (clinicaladvisor.com).

Conclusion: Finding ways to preserve and support physician autonomy is a key ingredient to preventing and treating physician burnout. If successful, it will mean happier doctors and better patient care.