• Christine A Sinsky, Roger L Brown, Lisa Rotenstein, Lindsey E Carlasare, Purva Shah, and Tait D Shanafelt.
• American Medical Association, Chicago, Illinois (C.A.S., L.E.C., P.S.).
• Ann. Intern. Med. 2024 Nov 26.

BackgroundPhysician control over their clinical work is hypothesized to be associated with both burnout and career intentions.ObjectiveTo assess the association of perceived work control with burnout and career intentions.DesignA multi-institution study.SettingCross-sectional survey.ParticipantsA sample of U.S. physicians between November 2022 and December 2023.MeasurementsA novel multicomponent measure of work control, Mini-Z single-item burnout measure, intent to reduce clinical hours (ITR), and intent to leave the current practice.ResultsAmong respondents, 61.4% (1318 of 2144) reported adequate control over patient load, 60.6% (1301 of 2144) adequate control over membership of their clinical team, and 61.3% (1434 of 2339) adequate control over workload. Adequate control over hiring of staff and clinical schedule were reported by 49.0% (772 of 1574) and 74.6% (1175 of 1574), respectively. Most respondents (58.3% [692 of 1186]) reported that they had sufficient authority/autonomy over that for which they are accountable. On multivariable analyses adjusting for personal and professional characteristics, poor control over patient load, team composition, clinical schedule, domains for which the physician is accountable, and workload were independently associated with burnout. Poor control over patient load and workload were each independently associated with ITR.LimitationThis is a cross-sectional study, so causation cannot be determined, and it is a convenience sample of practices with more than 100 physicians, so it may not be representative of all U.S. physicians.ConclusionIn this large, cross-sectional study, poor control over specific aspects of work was associated with burnout and intentions to reduce clinical effort or leave one's organization. Efforts to reduce burnout and improve retention should consider how to provide physician control over appropriate aspects of their clinical work environment.Primary Funding SourceAmerican Medical Association.

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