Dimensions of Burnout and Predictors of Physician Turnover in Clinical Practice

Physician burnout is associated with both intention to leave practice and turnover. However, the individual dimensions of burnout-cynicism, exhaustion, and poor personal efficacy-have not been examined as predictors of physician intent to leave practice or departure. We sought to determine whether these individual dimensions of burnout are independent predictors of physician intent to leave practice or departure.

In a retrospective cohort study, we merged longitudinal survey data from all actively employed physicians at the Massachusetts General Physicians Organization (MGPO) from 2017, 2019, and 2021 with physician employment status two years after survey completion.

Survey data were gathered from all actively employed physicians at the Massachusetts General Physicians Organization (MGPO), the largest physicians organization in New England and one of the largest in the USA.

There were 5976 survey responses from 2651 unique physicians over the three sequential survey years, with a survey response rate of > 90%.

Rates of self-reported intention to leave and actual physician departure among physicians were analyzed by general burnout scores and scores on the three individual burnout subscales.

Burnout was independently associated with both intention to leave (OR = 3.10, 95% CI 2.55-3.77) and physician departure (OR = 1.37, 95% CI 1.15-1.64). High scores on all three individual burnout subscales were associated with increased odds of intention to leave (exhaustion OR = 1.55, 95% CI 1.25-1.92; cynicism OR = 2.49, 95% CI 1.99-3.13; personal efficacy OR = 1.45, 95% CI 1.19-1.77). However, only high cynicism scores were associated with actual departure (cynicism OR = 1.37, 95% CI 1.12-1.68). Physicians who departed were significantly more likely to have previously expressed an intention to leave than those who remained (33.6% vs. 6.7%, p < 0.001).

Physician cynicism is the only burnout dimension associated with departure, though multiple burnout dimensions are associated with intention to leave. Organizational efforts to combat cynicism may be especially effective in promoting physician retention.