• Ryan Sterling, Seppo T Rinne, Ashok Reddy, Megan Moldestad, Peter Kaboli, Christian D Helfrich, Nora B Henrikson, Karin M Nelson, Catherine Kaminetzky, and Edwin S Wong.
• Center for Veteran-Centered and Value-Driven Care, VA Puget Sound Health Care System, Seattle, WA, USA. ryan.sterling@va.gov.
• J Gen Intern Med. 2022 Jan 1; 37 (1): 879487-94.

ObjectiveBurnout, or job-related stress, affects more than half of all US physicians, with primary care physicians (PCPs) experiencing some of the highest rates in medicine. Our study analyzes national survey data to identify and prioritize workplace climate predictors of burnout among PCPs within a large integrated health system.DesignObservational study of annual survey data from the Veterans Health Administration (VHA) All Employee Survey (AES) for 2013-2017. AES response rate ranged from 56 to 60% during the study period. Independent and dependent variables were measured from separate random samples. In total, 8,456 individual-level responses among PCPs at 110 VHA practice sites were aggregated at the facility level by reporting year. We used the semi-automated LASSO procedure to identify workplace climate measures that were more influential in predicting burnout and assessed relative importance using the Shapely value decomposition.ParticipantsVHA employees that self-identify as PCPs.Main MeasuresDependent variables included two dichotomous measures of burnout: emotional exhaustion and depersonalization. Independent measures included 30 survey measures related to dimensions of workplace climate (e.g., workload, leadership, satisfaction).ResultsWe identified seven influential workplace climate predictors of emotional exhaustion and nine predictors of depersonalization. With few exceptions, higher agreement/satisfaction scores for predictors were associated with a lower likelihood of burnout. 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%). The majority of explained variation in depersonalization was attributable to workload (25.3%), organization satisfaction (22.9%), and connection to VHA mission (20.7%).ConclusionIdentifying the relative importance of workplace climate is important for the allocation of health organization resources to mitigate and prevent burnout within the PCP workplace. In a context of limited resources, efforts to reduce perceived workload and improve organization satisfaction may represent the biggest leverage points for health organizations to address physician burnout.© 2021. This is a U.S. government work and not under copyright protection in the U.S.; foreign copyright protection may apply.

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