2019 HSR&D/QUERI National Conference

1133 — National trends and organizational risk factors for VA physician burnout

Lead/Presenter: Seppo Rinne,  COIN - Bedford/Boston
All Authors: Rinne ST (CHOIR/Bedford), Mohr, David C. (CHOIR, Boston), Wong, Edwin S. (Center of Innovation for Veteran-Centered & Value-Driven Care) Swamy, Lakshman (Boston University, The Pulmonary Center) Blok, Amanda (CHOIR, Bedford) Charns, Martin P. (CHOIR, Boston)

Physician burnout is a threat to learning health systems that depend on engaged and empowered clinicians participating in continuous system improvement. Few studies have described physician burnout in VA, and heterogeneity of non-VA physician burnout studies impairs analyses of longitudinal trends, geographic distribution, and organizational factors impacting physician burnout. Our primary objectives in this study were to characterize longitudinal burnout trends of VA physicians, categorize VA sites based on burnout trends, and assess organizational characteristics associated with physician burnout.

We conducted a longitudinal panel study of VA All Employee Survey responses during the period of 2013-2017. We characterized longitudinal burnout trends for physicians practicing in different service areas. All self-identified VA physicians practicing in one of eight core service areas were included. Burnout was defined using a validated definition based on two single-item measures adapted from the Maslach Burnout Inventory. We used clustering analysis to categorize sites based on their burnout rates over time, and compared organizational characteristics and geographic distribution of high, medium, and low burnout categories.

We identified 40,382 physician responses from 140 different VA sites. Mean burnout rates ranged from 34.3% in 2013 to a high of 39.0% in 2014. Primary care physicians had the highest burnout, followed by mental health and emergency medicine physicians. High burnout sites were more likely to be rural, non-teaching, have lower complexity (i.e., offer fewer advanced clinical services), and have fewer unique patients per site. High burnout sites also tended to be in the South.

VA physician burnout was lower than previously described in many non-VA studies and was relatively stable over time. These findings may relate to unique characteristics of the VA practice environment. Nonetheless, with over a third of VA physicians reporting burnout, organizational interventions are needed, particularly for primary care physicians and those practicing at small, rural sites.

Our results can help guide targeted interventions to promote VA physician well-being. These interventions are critical to ensuring an engaged workforce that promotes continuously learning care teams.