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Design and Participants: This cross-sectional study assessed the association of physicians’ perceived work control with burnout and career intentions, using the AMA Organizational Biopsy (40-item survey measuring workforce well-being). Two-level (organizations level–1, physicians level–2), random-effects logistic regression was conducted.
Results: Respondents (N=2,144 [86% full-time clinically; 35% inpatient/outpatient, 45% outpatient only, 15% inpatient only]; 5 academic, 14 nonacademic medical centers; and 3 safety-net, 16 non-safety-net organizations) were 41% female. Sixty-one percent reported adequate control (response of satisfactory/good/optimal) over patient load, 61% reported adequate control over team composition, 49% reported adequate influence over staff hiring, 75% reported adequate influence over setting clinical schedules, 58% reported adequate control over workload, and 61% reported their organization gives them sufficient authority/autonomy (agreed/strongly agreed) over work aspects for which they were accountable. On multivariable analyses adjusting for personal and professional characteristics, poor control over patient load (odds ratio=1.4 [95% CI=1.0-1.8]), team composition (1.7 [1.3-2.1]), clinical schedule (1.3 [1.0-1.7]), domains for which they were accountable (1.3 [1.0-1.6]), and workload (3.8 [3.0-4.9]) were independently associated with burnout. Poor control over patient load (1.6 [1.2-2.1]) and workload (1.4 [1.1-1.8]) were independently associated with ITR. Poor influence over staff hiring (1.6 [1.2-2.2]), poor control over work aspects for which they were accountable (1.4 [1.1-1.9]), and poor control over workload (1.4 [1.0-1.9]) were independently associated with ITL.
Commentary: For the many palliative care programs striving to maintain a healthy staff while facing growing expectations around clinical footprint and productivity, this study can inform leadership efforts to reduce burnout and enhance workplace autonomy. “Adequate control over one’s workload” was independently associated with all outcomes including burnout, ITR, and ITL and applies directly to our scope as palliative care physicians. Program leaders should involve physicians in discussions regarding clinical productivity, talking openly about patient volumes and clinician bandwidth. Physicians should also have a say in creation of the clinical schedule, pairings with advanced practice clinicians and trainees, and delegation of clinical tasks. The physician-centric nature of this study limits applicability to interdisciplinary palliative care teams.
Bottom Line: Poor control over workload and patient volumes are independently associated with physician burnout, and intent to both reduce clinical work and leave current position should be leadership targets to reduce burnout and enhance physician retention.
Reviewer: Andrew J. Lawton, MD FACP FAAHPM, Northwestern University Feinberg School of Medicine, Chicago, IL
References:
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Source: Sinsky CA, Brown RL, Rotenstein L, Carlasare LE, Shah P, Shanafelt TD. Association of work control with burnout and career intentions among U.S. Physicians: a multi-institution study. Ann Intern Med. 2025;178(1):20-28. doi:10.7326/ANNALS-24-00884.
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