Study Examines Telework Association with VA Physician Burnout During COVID Pandemic
BACKGROUND:
Many physicians were allowed to deliver telemedicine remotely from home during the early COVID-19 pandemic, but few still telework. It is unclear whether telework can mitigate physician burnout, as recent studies have included less than 1,000 individuals. This study examined whether physician burnout was associated with telework within the VA healthcare system. Investigators analyzed data from physicians who completed an annual electronic survey of all VA employees across 140 healthcare systems from 2020 to 2022 (average response rate was 69%). Physicians rated “I feel burned out from my work” and “I worry that this job is hardening me emotionally” as occurring “once a week” or more – on a scale from “never” to “every day.” Exposure variables included: no telework by choice, unable to telework (cannot perform duties from home), unapproved to telework, part-time telework, or full-time telework. In addition, investigators adjusted for physician characteristics (i.e., age, gender, race/ethnicity, employment duration) and healthcare system complexity (e.g., patient-case mix, rurality). Final study results included responses from 44,132 VA physicians: 23,414 (53%) were age 50 years or older; 24,818 (56%) were male; and 25,746 (58%) were white.
FINDINGS:
- VA physician burnout continued to increase during the COVID-19 pandemic. Averaged across 3 years (2020, 2021, and 2022), 35% of VA physicians reported burnout (29%, 36%, and 39%, respectively). Burnout was highest among primary care physicians (52%) and psychiatry (41%).
- More than half of physicians did not have telework arrangements – on average, 12% chose not to, 33% were unable to, and 11% were unapproved to telework.
- Adjusted odds of burnout were 57% higher for physicians who were unapproved to telework compared to those who were full-time telework: 43% vs 33% for all physicians, 52% vs 43% for psychiatry specialties, and 35% vs 26% for other physicians.
- Lower burnout was seen among primary care physicians with greater ability to telework: 47% (full-time) vs 52% (part-time) vs 61% (telework unapproved).
IMPLICATIONS:
- Telework has been linked to lower burnout, as well as higher autonomy and engagement, which is also associated with lower burnout. If flexible telework arrangements are associated with lower physician burnout, they have the potential to improve job retention and, in turn, quality of care.
LIMITATIONS:
- While this is the first study to examine telework and burnout over time among U.S. physicians, the study design does not permit causal inference.
- Investigators lacked information on potential confounders, like physician panel size or complexity.
AUTHOR/FUNDING INFORMATION:
Drs. Leung and Apaydin are supported by HSR&D Career Development Awards. Drs. Leung, Apaydin, Rose, Stockdale, and Ms. Yoo are part of HSR&D’s Center for the Study of Healthcare Innovation, Implementation, and Policy (CSHIIP).
Leung LB, Yoo C, Rose DE, Jackson NJ, Stockdale SE, and Apaydin EA. Research Letter: Telework Arrangements and Physician Burnout in the Veterans Health Administration. JAMA Network Open. October 27, 2023;6(10):e2340144.
