The Association of Team-Specific Workload and Staffing with Odds of Burnout Among VA Primary Care Team Members

J Gen Intern Med. 2017 Jul;32(7):760-766. doi: 10.1007/s11606-017-4011-4. Epub 2017 Feb 23.


Background: Work-related burnout is common in primary care and is associated with worse patient safety, patient satisfaction, and employee mental health. Workload, staffing stability, and team completeness may be drivers of burnout. However, few studies have assessed these associations at the team level, and fewer still include members of the team beyond physicians.

Objective: To study the associations of burnout among primary care providers (PCPs), nurse care managers, clinical associates (MAs, LPNs), and administrative clerks with the staffing and workload on their teams.

Design: We conducted an individual-level cross-sectional analysis of survey and administrative data in 2014.

Participants: Primary care personnel at VA clinics responding to a national survey.

Main measures: Burnout was measured with a validated single-item survey measure dichotomized to indicate the presence of burnout. The independent variables were survey measures of team staffing (having a fully staffed team, serving on multiple teams, and turnover on the team), and workload both from survey items (working extended hours), and administrative data (patient panel overcapacity and average panel comorbidity).

Key results: There were 4610 respondents (estimated response rate of 20.9%). The overall prevalence of burnout was 41%. In adjusted analyses, the strongest associations with burnout were having a fully staffed team (odds ratio [OR] = 0.55, 95% CI 0.47-0.65), having turnover on the team (OR = 1.67, 95% CI 1.43-1.94), and having patient panel overcapacity (OR = 1.19, 95% CI 1.01-1.40). The observed burnout prevalence was 30.1% lower (28.5% vs. 58.6%) for respondents working on fully staffed teams with no turnover and caring for a panel within capacity, relative to respondents in the inverse condition.

Conclusions: Complete team staffing, turnover among team members, and panel overcapacity had strong, cumulative associations with burnout. Further research is needed to understand whether improvements in these factors would lower burnout.

Keywords: burnout; patient-centered medical home; primary care staffing; primary care workload; team-based care.

MeSH terms

  • Burnout, Professional / diagnosis
  • Burnout, Professional / epidemiology
  • Burnout, Professional / psychology*
  • Cross-Sectional Studies
  • Female
  • Health Personnel / psychology*
  • Health Personnel / trends
  • Humans
  • Male
  • Patient Care Team / trends*
  • Personnel Staffing and Scheduling / trends
  • Physicians, Primary Care / trends
  • Primary Health Care* / trends
  • United States / epidemiology
  • United States Department of Veterans Affairs* / trends
  • Workload / psychology*