Identifying and Prioritizing Workplace Climate Predictors of Burnout Among VA Primary Care Physicians
Authors: Sterling R. , Rinne S. , Reddy A. , Moldestad M. , Kaboli P. , Helfrich C. , Henrikson N. , Nelson K. , Kaminetzky C. 
Published: August 2020

Burnout, or job‐related stress, affects more than half of all US physicians and has been linked to increased medical errors, staff turnover, and reduced productivity. Primary care physicians (PCPs) experience among the highest burnout rates in medicine. Workplace climate, defined as shared worker attitudes and perceptions of their work environment, is a leading determinant of physician burnout. However, prior studies have not examined the relative importance of different elements of workplace climate (eg, leadership, support). Our study identifies and prioritizes workplace climate predictors of physician burnout among PCPs employed by Veterans Affairs (VA) nationwide.

We conducted a cross‐sectional analysis of data from the 2013‐2017 VA All Employee Survey (AES), an annual organizational census that includes questions on burnout and workplace climate. Dependent variables addressed two dimensions of burnout from the Maslach Burnout Inventory (eg, emotional exhaustion and depersonalization); symptoms > once per week indicated burnout. Independent variables included 30 questions related to elements of workplace climate (ie, leadership, support, rewards, recognition, autonomy, satisfaction, tolerance, conflict, workload, growth opportunity, physical and psychological safety, communication, collaboration, risk‐taking, and sense of belonging and purpose) scored on a 5‐point agreement/satisfaction scale. We included PCP demographic covariates. Independent and dependent variables were measured from separate random samples to avoid method bias. Collapsing AES responses among PCPs on the medical‐site level by reporting year, we used the semi‐automated LASSO procedure to identify workplace climate predictors of burnout and assessed their relative importance using the Shapely value decomposition.

PCPs employed at 157 VA medical sites nationwide.

Among a sample of 305 facility‐year observations, an average of 65.5% of PCPs screened positive for emotional exhaustion and 47.8% for depersonalization. We identified 7 workplace climate predictors of emotional exhaustion (pseudo R2 for full model = 0.667). The majority of explained variation in emotional exhaustion was attributable to perceptions of workload (32.6%), organization satisfaction (28.2%), and organization support (19.4%); other contributors included praise (7.8%), employee development (8.1%), psychological safety (1.9%), and innovation (2.0%). We identified 9 workplace climate predictors of depersonalization (pseudo R2 for full model = 0.590). The majority of explained variation in depersonalization was attributable to workload (25.3%), organization satisfaction (22.9%), and connection to VA mission (20.7%); other contributors included job control (11.4%), praise (9.6%), work/family balance (9.1%), quality of direct supervision (<1%), psychological safety (<1%), and innovation (<1%). Apart from innovation, higher agreement/satisfaction scores for workplace climate predictors were associated with a lower likelihood of PCP burnout.

The most influential workplace climate predictors of burnout among PCPs included perceptions of workload, organization satisfaction, organization support, and connection to institutional mission. Praise, employee development, job control, and work/family balance were moderately influential.

Identifying and understanding the relative importance of workplace climate factors are important for guiding optimal allocation of health organization resources to mitigate and prevent burnout within the PCP workforce. To address burnout, our research suggests organizations should prioritize practices and policies that reduce physician workload and create a supportive work environment that promotes employee satisfaction and sense of connection to institutional mission.

Department of Veterans Affairs.