Organisational factors associated with burnout among emergency and internal medicine physicians: a qualitative study

To identify physician perspectives on factors associated with physician burnout, protective factors against burnout, and to seek potential solutions for this pervasive problem.

A qualitative study with semistructured focus group interviews using a systematic framework analysis.

Physicians from general internal medicine (GIM) and the emergency department (ED) at two urban tertiary care hospitals in Vancouver, Canada, were recruited. Separate GIM and ED physician focus groups were conducted virtually from July 2021 to December 2022, led by an independent facilitator. Audio recordings from focus group sessions were then transcribed for analysis.

41 physicians (29 GIM and 12 ED) participated in the focus groups. The dominant themes for organisational factors attributed to burnout that were highlighted by both groups included heavy workload and scheduling, frequent interruptions, interdepartmental conflict and feeling undervalued by leadership. Other contributing factors that were only emphasised by GIM physicians were pressure to work out-of-scope of their practice, pressure to admit and discharge patients quickly, as well as sexism in the workplace. Factors unique to ED physicians included experiencing violence in the workplace and having to assess patients in waiting rooms. Protective organisational factors included time to build rapport with patients, staff collegiality, working within their scope of practice, and feeling rewarded and valued by leadership. Interventions suggested by physicians included improving channels of communication between staff, increasing flexibility in scheduling and strengthening hospitalists' services.

Most organisational factors driving burnout were common to both GIM and ED physicians, including heavy workload and scheduling, frequent interruptions, interdepartmental conflict and feeling undervalued by leadership. Leveraging protective factors and intervening on organisational factors attributed to burnout such as improving communication and enhancing support services may be effective in addressing the physician burnout epidemic.