Burnout in Danish General Practice development, risk and prognosis Christina Maar Andersen, Cand.psych. Research Unit for General Practice Aarhus University Bartholins Allé 2 8000 Aarhus C Tel.: (0045) 87168056 E-mail: c.maar.andersen@alm.au.dk Financial support The Quality and Continuing Education Council for General Practice in the Central Denmark Region and the Committee of Multipractice Studies in General Practice.
Background Burnout among physicians is a growing problem. Burnout among physicians has implications for both the physicians and their patients. Mulligan K. Self care for general practitioners. Aust Fam Physician 1997 Jul;26(7):787-9. European Forum of Medical Associations and WHO. Statement on the burnout-syndrome among physicians. Berlin: EFMA; 2003. Wallace JE, Lemaire JB, Ghali WA. Physician wellness: a missing quality indicator. Lancet 2009 Nov 14;374(9702):1714-21
Agenda Current status of burnout among general practitioners. The development of burnout within the last 7 years. Age and gender differences in burnout. Risk factors associated with the development of burnout. Prognosis.
Burnout Emotional exhaustion Depersonalisation Moderate burnout: emotional exhaustion and/or depersonalisation Personal accomplishment Severe burnout: emotional exhaustion depersonalisation and personal accomplishment Maslach C, Jackson S. The measurement of experienced burn-out. Journal of Occupational Behavior 1981;2:99-113.
Methode In 2004, all GPs in Aarhus county (N = 458) were invited to participate in a study on burnout. 2012 follow-up among all GPs in Central Denmark Region (N = 835).
Development of burnout 2004: GPs in Aarhus county (N = 379) 2012: all GPs (N = 601) 2012: GPs in Aarhus county (N = 363) N n % 95% CI N n % 95% CI N n % 95% CI High degree of emotional exhaustion High degree of depersonalisation Low degree of personal accomplishment 371 38 10.2 7.4-13.8 595 107 18.0** 15.0-21.3 358 61 17.0** 13.3-21.3 373 66 17.7 14.0-22.0 596 83 13.9 11.2-17.0 358 41 11.5* 8.3-15.2 365 139 38.1 33.1-43.3 589 204 34.6 30.8-38.6 353 102 28.9** 24.2-33.9 Moderate burnout 369 89 24.1 19.8-28.8 592 153 25.8 22.4-29.6 355 82 2.1 18.8-27.8 Severe burnout 358 10 2.8 1.3-5.1 582 31 5.3 3.6-7.5 347 18 5.2 3.1-8.1 Pedersen, A. F.; Olesen, F.; Andersen, C. M.; Vedsted, P. 2012 Arbejdsbelastning blandt alment praktiserende læger: En undersøgelse i Region Midtjylland. Rapport, 1 ed. Aarhus: Research Unit for General Practice, 2012. 23 s.
Age differences 2012 Youngest age group (<45 years old) N=128 Middle age group (45-54 years old) N=199 Elder age group ( 55 years old) N=254 High degree of emotional exhaustion 126 25 N n % N n % N n % P- value 19.8 (13.3-27.9) 196 35 17.9 (12.8-23.9) 253 41 16.2 (11.9-21.3) 0.675 High degree of depersonalisation 128 24 18.8 (12.4-26.6) 195 29 14.9 (10.2-20.7) 253 27 10.7 (7.2-15.1) 0.087 Low degree of personal accomplishment 126 42 33.3 (25.2-42.3) 192 59 30.7 (24.3-37.8) 251 95 37.9 (31.8-44.2) 0.282 Moderate burnout 126 37 29.4 (21.6-38.1) 194 50 25.8 (19.8-32.5) 252 59 23.4 (18.3-29.1) 0.455 Severe burnout 124 10 8.1 (3.9-14.3) 189 10 5.3 (2.6-9.5) 249 9 3.6 (1.7-6.8) 0.186 Pedersen, A. F.; Olesen, F.; Andersen, C. M.; Vedsted, P. 2012 Arbejdsbelastning blandt alment praktiserende læger: En undersøgelse i Region Midtjylland. Rapport, 1 ed. Aarhus: Research Unit for General Practice, 2012. 23 s.
Gender differences 2012 Female GPs (N=284) Male GPs (N=312) N n % 95% CI N n % 95% CI P-value Moderate burnout 278 74 26.6 21.5-32.2 309 77 24.9 20.2-30.1 0.638 Severe burnout 272 10 3.7 1.8-6.7 305 20 6.6 4.1-9.9 0.120 Pedersen, A. F.; Olesen, F.; Andersen, C. M.; Vedsted, P. 2012 Arbejdsbelastning blandt alment praktiserende læger: En undersøgelse i Region Midtjylland. Rapport, 1 ed. Aarhus: Research Unit for General Practice, 2012. 23 s.
Age differences - 2012 Female GPs Youngest age group (<45 years old) N=72 N n % Moderate burnout Severe burnout 70 23 69 4 32.9 (22.1-45.1) 5.8 (1.6-14.2) Male GPs Youngest age group (<45 years old) N=128 N n % Moderate burnout Severe burnout 56 14 55 6 25.0 (14.4-38.4) 10.9 (4.1-22.2)) Pedersen, A. F.; Olesen, F.; Andersen, C. M.; Vedsted, P. 2012 Arbejdsbelastning blandt alment praktiserende læger: En undersøgelse i Region Midtjylland. Rapport, 1 ed. Aarhus: Research Unit for General Practice, 2012. 23 s.
Risk of developing burnout 2004 Not burned-out Burned-out Not burned-out 132 26 2012 Burned-out 20 23 The risk of developing burnout was 13.2% (95%CI: 0.08-0.20) Pedersen A.P.; Andersen, C. M.; Olesen, F; Vedsted, P. Risk of burnout in Danish GPs and exploration of factors associated with development of burnout: a two-wave panel study. International Journal of Family Medicine. (in press).
Predictors GPs who in 2004 did not answered yes to the question: Would family medicine still be your choice if you were to select your medical specialty today? had a 4.5 times increased risk of developing burnout in 2012 (OR=4.5; 95% CI: 1.2-16.5; p=0.023). Pedersen A.P.; Andersen, C. M.; Olesen, F; Vedsted, P. Risk of burnout in Danish GPs and exploration of factors associated with development of burnout: a two-wave panel study. International Journal of Family Medicine. (in press).
Prognosis withdrawel from general practice 26.1% of GPs who were burned-out in 2004 withdrew from practice compared to 31.0% of GPs who were not burned-out (adj. OR = 0.97; 95%CI: 0.48-1.96; p = 0.935) Pedersen A.P.; Andersen, C. M.; Olesen, F; Vedsted, P. Risk of burnout in Danish GPs and exploration of factors associated with development of burnout: a two-wave panel study. International Journal of Family Medicine. (in press).
Conclusion The degree of severe burnout has increased considerably since 2004. The risk of developing burnout was 13%. Not wanting to choose general practice again as a specialty" increased the risk of developing burnout by 4.5 time. Burned-out GPs appear not to have higher job turnover rates than GPs who are not burned-out.