Exploring Practice Diversity as a Prevention Strategy for Burnout: A Survey of Family Physicians

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Venables, Brian Hess, Loring Chuchmach, and 2 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-4184397/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Background : Physician burnout is a longstanding issue which has only intensified as a result of the COVID-19 pandemic. Earlier studies indicate that individuals in frontline specialties, such as family medicine, may be more susceptible to burnout, and interventions have primarily targeted reduced workloads and physician autonomy. However, we sought to explore work-life balance in relation to burnout prevention. We theorized that family physicians who participated in multiple clinical roles (e.g., outpatient practice, emergency) and included non-clinical roles (e.g., teaching, administration) within their practice would report lower burnout scores compared to family physicians with singular roles. METHODS : We utilized a cross-sectional survey, incorporating two validated burnout measures (Maslach Burnout Inventory and MiniZ-2.0), and compared burnout scores to family physician’s self reported number of and hours dedicated to both clinical and non-clinical roles. We surveyed family physicians in Ontario, Manitoba and British Columbia. RESULTS : Descriptive analysis suggested that as clinical and non-clinical roles increase, burnout scores decline. Correlational analysis showed that as non-clinical roles increase, emotional exhaustion scores decrease. Similarly, as non-clinical hours increase, family physicians reported a more joyful and manageable workplace. CONCLUSIONS : Our findings lend credence to the notion that the meaning in work, rather than the quantity of work, may be a driving factor in burnout. Thus, physicians should continue to diversify their practice with meaningful clinical and non-clinical activities to help prevent burnout. Family Practice burnout workload survey mental health Figures Figure 1 Background Burnout, while an innately individual experience, has become an undeniable issue for the healthcare system, particularly with the prevalence of physician burnout increasing worldwide. 1,2 While the focus on physician burnout has intensified, accentuated by the COVID-19 pandemic, the concept was initially described by American psychologist Freudenberger (1975), to describe the wearing out of individuals in health professions. Later, Maslach refined the definition to include its consequences, adding detachment from others, depersonalization, and reduced sense of personal accomplishment. 3,4 Earlier studies indicate that burnout is more common amongst frontline medical specialties such as family medicine. 2,5 Family physicians experiencing burnout report that they are more likely to reduce their patient loads or in extreme cases, leave practice and retire. 1 Thus, the effects of burnout extend beyond the individual to healthcare delivery. Studies reveal that burnout results in reduced productivity, increased physician turnover and higher healthcare costs. 6 Further, physicians were more likely to engage in poor patient care practices when experiencing burnout, 7,8 and were more likely to report medical errors. 9 Factors such as work overload, lack of autonomy, and incongruent values between physicians and healthcare organizations, are cited as significant risks for burnout. 10 Outpatient practice is speculated to be higher risk than inpatient care. 11,12 However, for those who do inpatient work, shorter rotations were shown to reduce self-reported burnout. 13 Thus, interventions to reduce burnout have tended to push for reduced workloads and physician independence. 14 Yet, others suggest that work-life balance is not the critical issue. 2 Rather, what has been proposed but not fully explored, is that physicians with multiple different roles may be protected against burnout. For example, family physicians who practice in multiple settings (e.g., hospital, patient homes) and practice psychosocial counselling in addition to their more traditional clinical work, appear less susceptible to burnout. 15,16 Further, it has also been argued that inclusion of non-clinical work, such as teaching or research, can combat burnout. 17 Given the potential impact of this finding, we hypothesized that family physicians with multiple clinical roles, such as emergency room and inpatient care, would report lower burnout scores compared to those with singular roles. Similarly, we theorized that family physicians who diversify their work to include non-clinical activities (e.g., teaching, administration), would also report lower burnout scores compared to those with only clinical work. Methods Study Design We used a cross-sectional survey, incorporating two burnout measures, MiniZ-2.0 and Maslach Burnout Inventory, to evaluate self-reported burnout levels of family physicians in the Canadian provinces of Ontario, Manitoba and British Columbia. The survey also captured family physician engagement in clinical and non-clinical work activities from May to July 2021. Research ethics approval was obtained from the appropriate institutions – Bruyère Continuing Care Research Ethics Board (file #M16-21-013) and the University of Manitoba Health Research Ethics Board (file #HS24510). The survey was distributed online, hosted by SurveyMonkey and distributed by email to members of the Manitoba, Ontario and British Columbia College of Family Physicians. Each institution was responsible for distributing the survey to the province’s family physicians. We collected survey responses for three months. No exclusion criteria were applied. Survey Development The survey required respondents to list the number of clinical and non-clinical roles that they considered part of their work as a family physician. Similarly, they were asked to approximate the hours dedicated to this work. We also asked respondents to indicate examples of clinical work (e.g., outpatient office practice, inpatient care, emergency room, obstetrical care, etc.) and non-clinical work (e.g., clinical teaching, scholarly research, faculty administration, etc.) in which they participated. Response options were identified based on feedback from five family physicians who piloted the survey at the Principal Investigator’s site. In addition to pre-populated options, respondents could provide open text answers. Respondents then completed the two burnout measurements. Survey questions were initially developed by the PI and select co-investigators. Questions were piloted with local family physicians, and additional options were included based on feedback. Validity of burnout measurements have been shown elsewhere 3,4,18 . The survey was distributed via newsletters and electronic mail at partner sites, so identifying the exact number of physicians who received a survey invitation is a limitation. Consent to participate was obtained via a disclosure statement preceding the survey and included resources should the respondent potentially identify their own burnout. Burnout Measurements Maslach Burnout Inventory (MBI-MP) Three subscale scores are created from the 22-item MBI-MP instrument by taking the mean across the relevant items as outlined in the MBI-MP survey instructions. This results in scores for emotional exhaustion (EE), depersonalization (DP) and personal accomplishment (PA). Items on the survey are scored on a 7-point scale from 0–6. Validity of the MBI has been demonstrated elsewhere. 4,18 Reliability of the three subscale scores as measured by Cronbach’s alpha (ranging from 0.733 to 0.844) was shown to be similar to what we measured in this study. 19 MiniZ-2.0 This scale created by Linzer et al., (2009) 20 and validated as a burnout measure incorporates two sub scores, containing 18 items, which are used to create a total MiniZ-2.0 score. 21 The Internal consistency of the ten-item survey MiniZ-2.0 was evaluated using a sample of 603 practicing physicians from Hennepin County Medical Center and found to have a Cronbach’s alpha of 0.8. 21 The two subscale scores include Supportive Work Environment and Work Pace and Electronic Medical Record (EMR) stress. These two subscale scores are added to create a Total MiniZ 2.0 score, coined the Joyful Workplace score. Question 2 of this scoring system was inadvertently left off the survey; therefore, Subscale 1 (Supportive Work Environment) scoring was reduced to adjust for this. Data Analysis Descriptive analyses and frequencies provide baseline characteristics of participants and detail time spent engaging in clinical and non-clinical activities. Burnout sub-scores were plotted against hours spent in clinical and non-clinical activities, as well as number of clinical and non-clinical activities, to identify trends. Relationships between the MBI and MiniZ-2.0 scales and total hours, as well as total number of clinical and non-clinical activities, were explored using Spearman's rank-order correlations. Reliability analyses using Cronbach's alpha was used to assess the subscales created from the MBI (MBI Total Exhaustion, MBI Depersonalization, MBI Personal Accomplishment) and Mini Z (MiniZ Supportive Work Environment, MiniZ Workpace, MiniZ Total Score) individual items. Results Baseline Characteristics There were 114 survey responses of which, 59 were family physicians from Manitoba, 37 from Ontario and 18 from British Columbia (See Table 1 ). [ Insert Table 1 ] Clinical and Non-Clinical Activities and Hours All participants were practicing clinicians with the majority spending at least 20 hours performing clinical duties. Additionally, the majority of responding physicians had one or fewer non-clinical roles and spent less than 5 hours per week on these roles. [ Insert Table 2 ] Descriptive Summary Clinical Hours and Clinical Activities Emotional exhaustion (EE) average scores are lowest for clinicians who participate in three clinical areas (see Fig. 1 a) and where clinical work totals 20–30 hours per week (see Fig. 1 b). However, as the number of clinical roles and hours increase, EE scores appear to increase. For depersonalization (DP) we found that as clinical hours increase, DP scores increase (Appendix A). As both clinical roles and clinical hours increase, personal accomplishment scores appear to increase. [ Insert Fig. 1 ] Scores relating to the supportive work environment dropped when physicians reported working over 40 hours per week. Conversely, participating in three clinical roles and working between 30–40 clinical hours per week resulted in the highest supportive work environment scores. Work pace scores were highest, reflecting a more manageable work pace, for physicians with two clinical roles and working 20–30 hours per week. Total scores on the MiniZ were steady for clinicians working less than 40 hours per week but decreased, reflecting higher burnout scores, once reports exceeded 40 hours per week. Total scores were highest, reflecting less burnout, for clinicians who had 2–3 clinical roles and lowest for physicians who only had one role. Non-Clinical Hours and Non-Clinical Activities As total number of non-clinical roles increase, it appears that EE scores decrease (See Fig. 1 c). However, as non-clinical hours increased, EE scores increased (See Fig. 1 d). The EE scores are lowest with 11–15 hours of non-clinical work. There are no discernible trends regarding the effect of non-clinical roles and hours on DP scores. Average personal accomplishment scores were highest for those who dedicated more than 20 hours per week to non-clinical roles. Similarly, individuals who had 6 or 7 non-clinical roles also reported the highest personal accomplishment (PA) averages. No discernable trends were observed for the number of non-clinical roles and supportive work environment scores. However, those with zero non-clinical roles reported the lowest work pace scores, reflecting a stressful work pace. Similarly, those who reported zero non-clinical roles had the lowest total MiniZ scores, reflecting the least joyful workplace. Correlation Summary As non-clinical roles increase, EE scores significantly decreased (-0.233, p < 0.05). Work pace scores and joyful workplace scores (MiniZ-2.0 total) improved with an increase in non-clinical hours (0.210, p < 0.05). Conversely, total clinical hours were negatively correlated with MiniZ Workpace scores (-0.189, p < 0.05). [ Insert Table 3 ] Internal Consistency of the Measures Reliability scores are reported in Table 4 . Cronbach’s alpha was used to assess the internal consistency or reliability of the created scales. This determines how items on a given scale are measuring for the same construct, in this case burnout. A higher alpha value indicates that the items in the scale are highly intercorrelated and therefore, measuring the same underlying construct. The range spans from 0 to 1, with values closer to 1 indicating high reliability (i.e., a high degree of consistency among the items in the created scale). Generally, a Cronbach’s alpha of .60 and above is considered acceptable; .70 and above is good; .80 and above is better, and .90 and above is best. [ Insert Table 4 ] Discussion This is the first study to specifically look at whether diversity in clinical and non-clinical practice impacts burnout. Prior studies have explored physicians with dual-roles and those who limited their practice to outpatient care but none have specifically considered the full-scale of roles in which family physicians may participate. 15,16 The traditional definition of a family physician has evolved over time with many frameworks highlighting this. The CanMEDS-Family Medicine roles encourages contemporary family physicians to be more than just clinicians and additionally highlights roles as leaders, scholars, health advocates and professionals. 22 The Fundamental Teaching Activities in Family Medicine maps the various roles of family medicine educators ranging from administration to curriculum design. 11 Our findings suggest that physicians with diverse non-clinical roles, including teaching, administration or health advocacy, have lower burnout scores, most notably emotional exhaustion. They were also more likely to report a manageable work pace and a more joyful workplace as measured by the MiniZ-2.0. Interestingly, while the same correlation was not seen with diversity in clinical roles, emotional exhaustion scores were lowest in those with three clinical roles. Previously, it was suggested that challenge and stimulation are key strategies to prevent burnout and perhaps, this diversity in practice is key. 23 Freudenberger (1975), when first defining burnout, described monotony as a key risk factor for burnout and thus, family physicians with varied practices may be protected. 24 We found that as total clinical hours increased, physicians reported higher work pace scores, reflecting a more chaotic work environment. In a study of internists who were deemed to be burned out, work control was viewed as marginal or poor. 12 We agree with others who have suggested that lack of control is a primary driver of burnout and we suspect that physicians with multiple roles likely have greater control over scheduling and obligations, given that they are not bound to one setting or administrator. 25 It has been suggested that enhancing the meaning of work is another key strategy to combating burnout and thus, physicians who feel free to tailor their work to their passions may be better protected against burnout. 17 The literature has also shown that allowing physicians to focus on what is most important to them, such as research or teaching, is inversely correlated with burnout. 17 Other literature suggests that fewer work hours may be helpful in preventing burnout. 6,26 While this is likely true in the extreme, as seen by the fact that a high number of hours both clinically and non-clinically result in elevated emotional exhaustion scores, this relationship may not be linear. Thus, the solution may not be to simply work less. We found that emotional exhaustion scores were lowest in those reporting between 20–30 hours of clinical work and 10–15 hours of non-clinical work. Furthermore, as clinical hours increased, the sense of personal accomplishment as measured by the MBI-MP increased. These findings perhaps highlight that family physicians derive job satisfaction from caring for patients, but the emotional tole of providing care may be mitigated by non-clinical work. As an extension, physicians who had significant amounts of non-clinical work (> 20 hours) reported higher emotional exhaustion scores, possibly owing to a lack of patient contact. Patient care remains the core tenant of a family physician’s job but, non-clinical work, tailored to one’s passions and interests, may serve as a buffer or alleviate the emotional cost of clinical work. Where to Next? It has been opined that to combat burnout, physicians should consider their own psychological needs, including a consideration of specific work that would be meaningful to each individual physician. 27 Such metacognition is a learned skill and it has been shown that participation in mindfulness courses correlates with lower burnout. 28 However, healthcare organizations also need to play a part. Many have argued that it is a shared responsibility to create organizations that support efforts to reduce burnout and reward physicians who pursue other meaningful non-clinical work such as teaching or leadership. 12,14,28 Additionally, we must model prevention strategies in training and be more explicit about the role of a physician extending beyond the direct care of patients (Lemire, 2018; Renting et al., 2017). 29,30 Conclusions This study explored family physicians with diverse clinical and non-clinical practices and its impact on burnout scores compared to those with singular roles. Our findings demonstrate that as non-clinical roles increased, there was a corresponding decrease in burnout scores measured by the MBI-MP and MiniZ-2.0, reflecting lower levels of burnout. However, our descriptive analysis also highlights patient care as a critical aspect of a family physician’s role and is key to a sense of personal accomplishment. It is likely that non-clinical work that is of interest to a family physician is helpful in shielding one from the emotional cost that is accrued from the challenging work that is patient care. Abbreviations Maslach Burnout Inventory – MBI-MP Emotional exhaustion – EE Depersonalization – DP Personal accomplishment – PA Declarations Clinical Trial No.: Not applicable Declarations: The authors confirm this research manuscript meets the checklist and reporting guidelines for qualitative research (COREQ) as per BMC Medical Education requirements. Ethics approval and consent to participate: Research ethics approval was obtained from the appropriate institutions: Bruyère Continuing Care Research Ethics Board (file #M16-21-013), University of Manitoba Health Research Ethics Board (file #HS24510). Consent to participate in research was obtained prior to the survey via disclosure statement. Consent for publication: Consent to participate included consent for publication of results. Availability of data and material: The authors do not have any research data outside the submitted manuscript file, and have no research data declaration(s), nor is a link/accession number available. Competing Interests: All authors have no competing interests, financial or otherwise, to declare. Funding: Not applicable; none to declare. Authors’ contributions : The manuscript was prepared collaboratively and the authors (Jattan, Venables, Hess, Chuchmach, LaBine, Archibald) are the sole contributors to its content. 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Medical Education. 2017;51. https://doi.org/10.1111/medu.13335 Tables Tables 1 to 4 are available in the Supplementary Files section. Additional Declarations No competing interests reported. Supplementary Files Table1234.docx AppendixA.docx Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-4184397","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":318350152,"identity":"a7625a25-ed94-47c1-966b-fcf06d46fae6","order_by":0,"name":"Aaron Jattan","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAABCklEQVRIiWNgGAWjYBACNgglB6E+gAhmMMIN+GE6eYCaGWeAtTDj1yLZgKSFmYcBYg1eLQbHzz58XMDAJm8v3/zssW3bNnlzdv6DjwtqGOT5G3BoOZNubDyDgc2wh43N3Di37bbhzmZmZuMZxxgMZxzAoeVAGps0DwMbYw8bg5k0UAvjhsPMQBE2hgQGHFrszz8Da7HvYWP/Jm3ZdtseouUfQ4I8LltugG1xS+xh4zGTZmy7nQjWwtvGkGCAU8szZmMeg5zknmM5ZZI9524nA7UYG8/skzDciEvL+TTGxzwVFrbtzce3Sfwou2274fxBYBh+s5GXw6EFqhFTSAKf+lEwCkbBKBgFBAAAhjVN6KDiaH0AAAAASUVORK5CYII=","orcid":"","institution":"University of Manitoba","correspondingAuthor":true,"prefix":"","firstName":"Aaron","middleName":"","lastName":"Jattan","suffix":""},{"id":318350153,"identity":"545697b6-1561-417e-8148-9dda2d6b9119","order_by":1,"name":"Maddie J. Venables","email":"","orcid":"","institution":"University of Ottawa","correspondingAuthor":false,"prefix":"","firstName":"Maddie","middleName":"J.","lastName":"Venables","suffix":""},{"id":318350154,"identity":"9edef978-92fa-4450-b1ae-157fc5a6e6b9","order_by":2,"name":"Brian Hess","email":"","orcid":"","institution":"College of Family Physicians of Canada","correspondingAuthor":false,"prefix":"","firstName":"Brian","middleName":"","lastName":"Hess","suffix":""},{"id":318350155,"identity":"87ddfb8e-973a-49b0-87b0-1cea40fc4ecc","order_by":3,"name":"Loring Chuchmach","email":"","orcid":"","institution":"George \u0026 Fay Yee Centre for Healthcare Innovation","correspondingAuthor":false,"prefix":"","firstName":"Loring","middleName":"","lastName":"Chuchmach","suffix":""},{"id":318350156,"identity":"a995de60-70f9-42e6-b05e-92ff7f5e6d7e","order_by":4,"name":"Lisa LaBine","email":"","orcid":"","institution":"University of Manitoba","correspondingAuthor":false,"prefix":"","firstName":"Lisa","middleName":"","lastName":"LaBine","suffix":""},{"id":318350157,"identity":"ebe6161c-2054-4d76-aadb-594824185f8d","order_by":5,"name":"Douglas Archibald","email":"","orcid":"","institution":"Bruyère Research Institute","correspondingAuthor":false,"prefix":"","firstName":"Douglas","middleName":"","lastName":"Archibald","suffix":""}],"badges":[],"createdAt":"2024-03-28 20:44:27","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-4184397/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-4184397/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":60610997,"identity":"e793d5d5-040a-4129-ad4b-0fb4b9db0dd7","added_by":"auto","created_at":"2024-07-18 18:34:36","extension":"jpeg","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":376115,"visible":true,"origin":"","legend":"\u003cp\u003eDescriptive Trends\u003c/p\u003e","description":"","filename":"floatimage3.jpeg","url":"https://assets-eu.researchsquare.com/files/rs-4184397/v1/530e8a184c39e20ef491edde.jpeg"},{"id":60611520,"identity":"195bc4f6-2aa5-4feb-bb79-0e56a9067b01","added_by":"auto","created_at":"2024-07-18 18:42:40","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":747267,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-4184397/v1/f49868ae-2945-4c0a-afbc-325e317ffbcc.pdf"},{"id":60610561,"identity":"b9f71ddf-94cd-4baa-a8d1-d87b6135209c","added_by":"auto","created_at":"2024-07-18 18:26:36","extension":"docx","order_by":1,"title":"","display":"","copyAsset":false,"role":"supplement","size":98230,"visible":true,"origin":"","legend":"","description":"","filename":"Table1234.docx","url":"https://assets-eu.researchsquare.com/files/rs-4184397/v1/c1f4cc80004947227ca9940f.docx"},{"id":60610563,"identity":"0463908e-3bc1-40b0-bf91-980c4746e536","added_by":"auto","created_at":"2024-07-18 18:26:37","extension":"docx","order_by":2,"title":"","display":"","copyAsset":false,"role":"supplement","size":2029447,"visible":true,"origin":"","legend":"","description":"","filename":"AppendixA.docx","url":"https://assets-eu.researchsquare.com/files/rs-4184397/v1/bf4f014496fad934e239ae46.docx"}],"financialInterests":"No competing interests reported.","formattedTitle":"Exploring Practice Diversity as a Prevention Strategy for Burnout: A Survey of Family Physicians","fulltext":[{"header":"Background","content":"\u003cp\u003eBurnout, while an innately individual experience, has become an undeniable issue for the healthcare system, particularly with the prevalence of physician burnout increasing worldwide.\u003csup\u003e1,2\u003c/sup\u003e While the focus on physician burnout has intensified, accentuated by the COVID-19 pandemic, the concept was initially described by American psychologist Freudenberger (1975), to describe the wearing out of individuals in health professions. Later, Maslach refined the definition to include its consequences, adding detachment from others, depersonalization, and reduced sense of personal accomplishment.\u003csup\u003e3,4\u003c/sup\u003e\u003c/p\u003e \u003cp\u003eEarlier studies indicate that burnout is more common amongst frontline medical specialties such as family medicine.\u003csup\u003e2,5\u003c/sup\u003e Family physicians experiencing burnout report that they are more likely to reduce their patient loads or in extreme cases, leave practice and retire.\u003csup\u003e1\u003c/sup\u003e Thus, the effects of burnout extend beyond the individual to healthcare delivery. Studies reveal that burnout results in reduced productivity, increased physician turnover and higher healthcare costs.\u003csup\u003e6\u003c/sup\u003e Further, physicians were more likely to engage in poor patient care practices when experiencing burnout,\u003csup\u003e7,8\u003c/sup\u003e and were more likely to report medical errors.\u003csup\u003e9\u003c/sup\u003e\u003c/p\u003e \u003cp\u003eFactors such as work overload, lack of autonomy, and incongruent values between physicians and healthcare organizations, are cited as significant risks for burnout.\u003csup\u003e10\u003c/sup\u003e Outpatient practice is speculated to be higher risk than inpatient care.\u003csup\u003e11,12\u003c/sup\u003e However, for those who do inpatient work, shorter rotations were shown to reduce self-reported burnout.\u003csup\u003e13\u003c/sup\u003e Thus, interventions to reduce burnout have tended to push for reduced workloads and physician independence.\u003csup\u003e14\u003c/sup\u003e Yet, others suggest that work-life balance is not the critical issue.\u003csup\u003e2\u003c/sup\u003e Rather, what has been proposed but not fully explored, is that physicians with multiple different roles may be protected against burnout. For example, family physicians who practice in multiple settings (e.g., hospital, patient homes) and practice psychosocial counselling in addition to their more traditional clinical work, appear less susceptible to burnout.\u003csup\u003e15,16\u003c/sup\u003e Further, it has also been argued that inclusion of non-clinical work, such as teaching or research, can combat burnout.\u003csup\u003e17\u003c/sup\u003e\u003c/p\u003e \u003cp\u003eGiven the potential impact of this finding, we hypothesized that family physicians with multiple clinical roles, such as emergency room and inpatient care, would report lower burnout scores compared to those with singular roles. Similarly, we theorized that family physicians who diversify their work to include non-clinical activities (e.g., teaching, administration), would also report lower burnout scores compared to those with only clinical work.\u003c/p\u003e"},{"header":"Methods","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003eStudy Design\u003c/h2\u003e \u003cp\u003eWe used a cross-sectional survey, incorporating two burnout measures, MiniZ-2.0 and Maslach Burnout Inventory, to evaluate self-reported burnout levels of family physicians in the Canadian provinces of Ontario, Manitoba and British Columbia. The survey also captured family physician engagement in clinical and non-clinical work activities from May to July 2021.\u003c/p\u003e \u003cp\u003e Research ethics approval was obtained from the appropriate institutions \u0026ndash; Bruy\u0026egrave;re Continuing Care Research Ethics Board (file #M16-21-013) and the University of Manitoba Health Research Ethics Board (file #HS24510). The survey was distributed online, hosted by SurveyMonkey and distributed by email to members of the Manitoba, Ontario and British Columbia College of Family Physicians. Each institution was responsible for distributing the survey to the province\u0026rsquo;s family physicians. We collected survey responses for three months. No exclusion criteria were applied.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec4\" class=\"Section2\"\u003e \u003ch2\u003eSurvey Development\u003c/h2\u003e \u003cp\u003eThe survey required respondents to list the number of clinical and non-clinical roles that they considered part of their work as a family physician. Similarly, they were asked to approximate the hours dedicated to this work. We also asked respondents to indicate examples of clinical work (e.g., outpatient office practice, inpatient care, emergency room, obstetrical care, etc.) and non-clinical work (e.g., clinical teaching, scholarly research, faculty administration, etc.) in which they participated. Response options were identified based on feedback from five family physicians who piloted the survey at the Principal Investigator\u0026rsquo;s site. In addition to pre-populated options, respondents could provide open text answers. Respondents then completed the two burnout measurements.\u003c/p\u003e \u003cp\u003eSurvey questions were initially developed by the PI and select co-investigators. Questions were piloted with local family physicians, and additional options were included based on feedback. Validity of burnout measurements have been shown elsewhere\u003csup\u003e3,4,18\u003c/sup\u003e. The survey was distributed via newsletters and electronic mail at partner sites, so identifying the exact number of physicians who received a survey invitation is a limitation. Consent to participate was obtained via a disclosure statement preceding the survey and included resources should the respondent potentially identify their own burnout.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec5\" class=\"Section2\"\u003e \u003ch2\u003eBurnout Measurements\u003c/h2\u003e \u003cdiv id=\"Sec6\" class=\"Section3\"\u003e \u003ch2\u003eMaslach Burnout Inventory (MBI-MP)\u003c/h2\u003e \u003cp\u003eThree subscale scores are created from the 22-item MBI-MP instrument by taking the mean across the relevant items as outlined in the MBI-MP survey instructions. This results in scores for emotional exhaustion (EE), depersonalization (DP) and personal accomplishment (PA). Items on the survey are scored on a 7-point scale from 0\u0026ndash;6. Validity of the MBI has been demonstrated elsewhere.\u003csup\u003e4,18\u003c/sup\u003e Reliability of the three subscale scores as measured by Cronbach\u0026rsquo;s alpha (ranging from 0.733 to 0.844) was shown to be similar to what we measured in this study.\u003csup\u003e19\u003c/sup\u003e\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv id=\"Sec7\" class=\"Section2\"\u003e \u003ch2\u003eMiniZ-2.0\u003c/h2\u003e \u003cp\u003eThis scale created by Linzer et al., (2009)\u003csup\u003e20\u003c/sup\u003e and validated as a burnout measure incorporates two sub scores, containing 18 items, which are used to create a total MiniZ-2.0 score.\u003csup\u003e21\u003c/sup\u003e The Internal consistency of the ten-item survey MiniZ-2.0 was evaluated using a sample of 603 practicing physicians from Hennepin County Medical Center and found to have a Cronbach\u0026rsquo;s alpha of 0.8.\u003csup\u003e21\u003c/sup\u003e The two subscale scores include Supportive Work Environment and Work Pace and Electronic Medical Record (EMR) stress. These two subscale scores are added to create a Total MiniZ 2.0 score, coined the Joyful Workplace score. Question 2 of this scoring system was inadvertently left off the survey; therefore, Subscale 1 (Supportive Work Environment) scoring was reduced to adjust for this.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec8\" class=\"Section2\"\u003e \u003ch2\u003eData Analysis\u003c/h2\u003e \u003cp\u003eDescriptive analyses and frequencies provide baseline characteristics of participants and detail time spent engaging in clinical and non-clinical activities. Burnout sub-scores were plotted against hours spent in clinical and non-clinical activities, as well as number of clinical and non-clinical activities, to identify trends. Relationships between the MBI and MiniZ-2.0 scales and total hours, as well as total number of clinical and non-clinical activities, were explored using Spearman's rank-order correlations.\u003c/p\u003e \u003cp\u003eReliability analyses using Cronbach's alpha was used to assess the subscales created from the MBI (MBI Total Exhaustion, MBI Depersonalization, MBI Personal Accomplishment) and Mini Z (MiniZ Supportive Work Environment, MiniZ Workpace, MiniZ Total Score) individual items.\u003c/p\u003e \u003c/div\u003e "},{"header":"Results","content":"\u003cdiv id=\"Sec11\" class=\"Section2\"\u003e \u003ch2\u003eBaseline Characteristics\u003c/h2\u003e \u003cp\u003eThere were 114 survey responses of which, 59 were family physicians from Manitoba, 37 from Ontario and 18 from British Columbia (See Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e[\u003cem\u003eInsert\u003c/em\u003e Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e]\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec12\" class=\"Section2\"\u003e \u003ch2\u003eClinical and Non-Clinical Activities and Hours\u003c/h2\u003e \u003cp\u003eAll participants were practicing clinicians with the majority spending at least 20 hours performing clinical duties. Additionally, the majority of responding physicians had one or fewer non-clinical roles and spent less than 5 hours per week on these roles.\u003c/p\u003e \u003cp\u003e[\u003cem\u003eInsert Table\u0026nbsp;2\u003c/em\u003e]\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec13\" class=\"Section2\"\u003e \u003ch2\u003eDescriptive Summary\u003c/h2\u003e \u003cdiv id=\"Sec14\" class=\"Section3\"\u003e \u003ch2\u003eClinical Hours and Clinical Activities\u003c/h2\u003e \u003cp\u003eEmotional exhaustion (EE) average scores are lowest for clinicians who participate in three clinical areas (see Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003ea) and where clinical work totals 20\u0026ndash;30 hours per week (see Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003eb). However, as the number of clinical roles and hours increase, EE scores appear to increase. For depersonalization (DP) we found that as clinical hours increase, DP scores increase (Appendix A). As both clinical roles and clinical hours increase, personal accomplishment scores appear to increase.\u003c/p\u003e \u003cp\u003e[\u003cem\u003eInsert\u003c/em\u003e Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e]\u003c/p\u003e \u003cp\u003eScores relating to the supportive work environment dropped when physicians reported working over 40 hours per week. Conversely, participating in three clinical roles and working between 30\u0026ndash;40 clinical hours per week resulted in the highest supportive work environment scores. Work pace scores were highest, reflecting a more manageable work pace, for physicians with two clinical roles and working 20\u0026ndash;30 hours per week.\u003c/p\u003e \u003cp\u003eTotal scores on the MiniZ were steady for clinicians working less than 40 hours per week but decreased, reflecting higher burnout scores, once reports exceeded 40 hours per week. Total scores were highest, reflecting less burnout, for clinicians who had 2\u0026ndash;3 clinical roles and lowest for physicians who only had one role.\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv id=\"Sec15\" class=\"Section2\"\u003e \u003ch2\u003eNon-Clinical Hours and Non-Clinical Activities\u003c/h2\u003e \u003cp\u003eAs total number of non-clinical roles increase, it appears that EE scores decrease (See Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003ec). However, as non-clinical hours increased, EE scores increased (See Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003ed). The EE scores are lowest with 11\u0026ndash;15 hours of non-clinical work. There are no discernible trends regarding the effect of non-clinical roles and hours on DP scores. Average personal accomplishment scores were highest for those who dedicated more than 20 hours per week to non-clinical roles. Similarly, individuals who had 6 or 7 non-clinical roles also reported the highest personal accomplishment (PA) averages.\u003c/p\u003e \u003cp\u003eNo discernable trends were observed for the number of non-clinical roles and supportive work environment scores. However, those with zero non-clinical roles reported the lowest work pace scores, reflecting a stressful work pace. Similarly, those who reported zero non-clinical roles had the lowest total MiniZ scores, reflecting the least joyful workplace.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec16\" class=\"Section2\"\u003e \u003ch2\u003eCorrelation Summary\u003c/h2\u003e \u003cp\u003eAs non-clinical roles increase, EE scores significantly decreased (-0.233, p\u0026thinsp;\u0026lt;\u0026thinsp;0.05). Work pace scores and joyful workplace scores (MiniZ-2.0 total) improved with an increase in non-clinical hours (0.210, p\u0026thinsp;\u0026lt;\u0026thinsp;0.05). Conversely, total clinical hours were negatively correlated with MiniZ Workpace scores (-0.189, p\u0026thinsp;\u0026lt;\u0026thinsp;0.05).\u003c/p\u003e \u003cp\u003e[\u003cem\u003eInsert\u003c/em\u003e Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e]\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec17\" class=\"Section2\"\u003e \u003ch2\u003eInternal Consistency of the Measures\u003c/h2\u003e \u003cp\u003eReliability scores are reported in Table\u0026nbsp;\u003cspan refid=\"Tab4\" class=\"InternalRef\"\u003e4\u003c/span\u003e. Cronbach\u0026rsquo;s alpha was used to assess the internal consistency or reliability of the created scales. This determines how items on a given scale are measuring for the same construct, in this case burnout. A higher alpha value indicates that the items in the scale are highly intercorrelated and therefore, measuring the same underlying construct. The range spans from 0 to 1, with values closer to 1 indicating high reliability (i.e., a high degree of consistency among the items in the created scale). Generally, a Cronbach\u0026rsquo;s alpha of .60 and above is considered acceptable; .70 and above is good; .80 and above is better, and .90 and above is best.\u003c/p\u003e \u003cp\u003e[\u003cem\u003eInsert\u003c/em\u003e Table\u0026nbsp;\u003cspan refid=\"Tab4\" class=\"InternalRef\"\u003e4\u003c/span\u003e]\u003c/p\u003e \u003c/div\u003e"},{"header":"Discussion","content":"\u003cp\u003eThis is the first study to specifically look at whether diversity in clinical and non-clinical practice impacts burnout. Prior studies have explored physicians with dual-roles and those who limited their practice to outpatient care but none have specifically considered the full-scale of roles in which family physicians may participate.\u003csup\u003e15,16\u003c/sup\u003e The traditional definition of a family physician has evolved over time with many frameworks highlighting this. The CanMEDS-Family Medicine roles encourages contemporary family physicians to be more than just clinicians and additionally highlights roles as leaders, scholars, health advocates and professionals.\u003csup\u003e22\u003c/sup\u003e The Fundamental Teaching Activities in Family Medicine maps the various roles of family medicine educators ranging from administration to curriculum design.\u003csup\u003e11\u003c/sup\u003e\u003c/p\u003e \u003cp\u003eOur findings suggest that physicians with diverse non-clinical roles, including teaching, administration or health advocacy, have lower burnout scores, most notably emotional exhaustion. They were also more likely to report a manageable work pace and a more joyful workplace as measured by the MiniZ-2.0. Interestingly, while the same correlation was not seen with diversity in clinical roles, emotional exhaustion scores were lowest in those with three clinical roles. Previously, it was suggested that challenge and stimulation are key strategies to prevent burnout and perhaps, this diversity in practice is key.\u003csup\u003e23\u003c/sup\u003e Freudenberger (1975), when first defining burnout, described monotony as a key risk factor for burnout and thus, family physicians with varied practices may be protected.\u003csup\u003e24\u003c/sup\u003e\u003c/p\u003e \u003cp\u003eWe found that as total clinical hours increased, physicians reported higher work pace scores, reflecting a more chaotic work environment. In a study of internists who were deemed to be burned out, work control was viewed as marginal or poor.\u003csup\u003e12\u003c/sup\u003e We agree with others who have suggested that lack of control is a primary driver of burnout and we suspect that physicians with multiple roles likely have greater control over scheduling and obligations, given that they are not bound to one setting or administrator.\u003csup\u003e25\u003c/sup\u003e It has been suggested that enhancing the meaning of work is another key strategy to combating burnout and thus, physicians who feel free to tailor their work to their passions may be better protected against burnout.\u003csup\u003e17\u003c/sup\u003e The literature has also shown that allowing physicians to focus on what is most important to them, such as research or teaching, is inversely correlated with burnout.\u003csup\u003e17\u003c/sup\u003e\u003c/p\u003e \u003cp\u003eOther literature suggests that fewer work hours may be helpful in preventing burnout.\u003csup\u003e6,26\u003c/sup\u003e While this is likely true in the extreme, as seen by the fact that a high number of hours both clinically and non-clinically result in elevated emotional exhaustion scores, this relationship may not be linear. Thus, the solution may not be to simply work less. We found that emotional exhaustion scores were lowest in those reporting between 20\u0026ndash;30 hours of clinical work and 10\u0026ndash;15 hours of non-clinical work. Furthermore, as clinical hours increased, the sense of personal accomplishment as measured by the MBI-MP increased. These findings perhaps highlight that family physicians derive job satisfaction from caring for patients, but the emotional tole of providing care may be mitigated by non-clinical work. As an extension, physicians who had significant amounts of non-clinical work (\u0026gt;\u0026thinsp;20 hours) reported higher emotional exhaustion scores, possibly owing to a lack of patient contact. Patient care remains the core tenant of a family physician\u0026rsquo;s job but, non-clinical work, tailored to one\u0026rsquo;s passions and interests, may serve as a buffer or alleviate the emotional cost of clinical work.\u003c/p\u003e \u003cp\u003e \u003cem\u003eWhere to Next?\u003c/em\u003e \u003c/p\u003e \u003cp\u003eIt has been opined that to combat burnout, physicians should consider their own psychological needs, including a consideration of specific work that would be meaningful to each individual physician.\u003csup\u003e27\u003c/sup\u003e Such metacognition is a learned skill and it has been shown that participation in mindfulness courses correlates with lower burnout.\u003csup\u003e28\u003c/sup\u003e However, healthcare organizations also need to play a part. Many have argued that it is a shared responsibility to create organizations that support efforts to reduce burnout and reward physicians who pursue other meaningful non-clinical work such as teaching or leadership.\u003csup\u003e12,14,28\u003c/sup\u003e Additionally, we must model prevention strategies in training and be more explicit about the role of a physician extending beyond the direct care of patients (Lemire, 2018; Renting et al., 2017).\u003csup\u003e29,30\u003c/sup\u003e\u003c/p\u003e"},{"header":"Conclusions","content":"\u003cp\u003eThis study explored family physicians with diverse clinical and non-clinical practices and its impact on burnout scores compared to those with singular roles. Our findings demonstrate that as non-clinical roles increased, there was a corresponding decrease in burnout scores measured by the MBI-MP and MiniZ-2.0, reflecting lower levels of burnout. However, our descriptive analysis also highlights patient care as a critical aspect of a family physician\u0026rsquo;s role and is key to a sense of personal accomplishment. It is likely that non-clinical work that is of interest to a family physician is helpful in shielding one from the emotional cost that is accrued from the challenging work that is patient care.\u0026nbsp;\u003c/p\u003e"},{"header":"Abbreviations","content":"\u003cp\u003eMaslach Burnout Inventory \u0026ndash; MBI-MP\u003c/p\u003e\n\u003cp\u003eEmotional exhaustion \u0026ndash; EE\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eDepersonalization \u0026ndash; DP\u0026nbsp;\u003c/p\u003e\n\u003cp\u003ePersonal accomplishment \u0026ndash; PA\u0026nbsp;\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eClinical Trial No.:\u003c/strong\u003e Not applicable\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eDeclarations:\u0026nbsp;\u003c/strong\u003eThe authors confirm this research manuscript meets the checklist and reporting guidelines for qualitative research (COREQ) as per BMC Medical Education requirements.\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eEthics approval and consent to participate:\u0026nbsp;\u003c/em\u003eResearch ethics approval was obtained from the appropriate institutions: Bruy\u0026egrave;re Continuing Care Research Ethics Board (file #M16-21-013), University of Manitoba Health Research Ethics Board (file #HS24510).\u0026nbsp;Consent to participate in research was obtained prior to the survey via disclosure statement.\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eConsent for publication:\u003c/em\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003eConsent to participate included consent for publication of results.\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eAvailability of data and material:\u003c/em\u003e The authors do not have any research data outside the submitted manuscript file, and have no research data declaration(s), nor is a link/accession number available.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eCompeting Interests:\u0026nbsp;\u003c/em\u003eAll authors have no competing interests, financial or otherwise, to declare.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eFunding:\u003c/em\u003e Not applicable; none to declare.\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eAuthors\u0026rsquo; contributions\u003c/em\u003e:\u0026nbsp;The manuscript was prepared collaboratively and the authors (Jattan, Venables, Hess, Chuchmach, LaBine, Archibald) are the sole contributors to its content.\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eAcknowledgements\u003c/em\u003e: Not applicable; none to declare.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n \u003cli\u003eDel Carmen MG, Herman J, Rao S, Hidrue MK, Ting D, Lehrhoff SR, et al. Trends and Factors Associated With Physician Burnout at a Multispecialty Academic Faculty Practice Organization. JAMA Network Open. 2019;2(3): e190554\u0026ndash;e190554. https://doi.org/10.1001/jamanetworkopen.2019.0554\u003c/li\u003e\n \u003cli\u003eShanafelt TD, Hasan O, Dyrbye LN, Sinsky C, Satele D, Sloan J, et al. Changes in Burnout and Satisfaction With Work-Life Balance in Physicians and the General US Working Population Between 2011 and 2014. Mayo Clinic Proceedings. 2015;90(12): 1600\u0026ndash;1613. https://doi.org/10.1016/j.mayocp.2015.08.023\u003c/li\u003e\n \u003cli\u003eMaslach C. A Multidimensional Theory of Burnout; 1998. p. 68\u0026ndash;85.\u003c/li\u003e\n \u003cli\u003eMaslach C, Jackson SE. The Measurement of Experienced Burnout. Journal of Occupational Behaviour. 1981;2(2): 99\u0026ndash;113.\u003c/li\u003e\n \u003cli\u003eLee RT, Seo B, Hladkyj S, Lovell BL, Schwartzmann L. Correlates of physician burnout across regions and specialties: a meta-analysis. 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Physician Burnout, Well-being, and Work Unit Safety Grades in Relationship to Reported Medical Errors. Mayo Clinic Proceedings. 2018;93(11): 1571\u0026ndash;1580. https://doi.org/10.1016/j.mayocp.2018.05.014\u003c/li\u003e\n \u003cli\u003eRothenberger DA. Physician Burnout and Well-Being: A Systematic Review and Framework for Action. Diseases of the Colon \u0026amp; Rectum. 2017;60(6): 567\u0026ndash;576. https://doi.org/10.1097/DCR.0000000000000844\u003c/li\u003e\n \u003cli\u003eLee-Krueger RCW, Moreau K, Delva D, Eady K, Giroux CM, Archibald D. Fundamental Teaching Activities in Family Medicine Framework: Analysis of Awareness and Utilization. Journal of Continuing Education in the Health Professions. 2022;42(4): 274-83. https://journals.lww.com/jcehp/Fulltext/9000/Fundamental_Teaching_Activities_in_Family_Medicine.99783.aspx\u003c/li\u003e\n \u003cli\u003eLinzer M, Poplau S, Babbott S, Collins T, Guzman-Corrales L, Menk J, et al. Worklife and Wellness in Academic General Internal Medicine: Results from a National Survey. Journal of General Internal Medicine. 2016;31(9): 1004\u0026ndash;1010. https://doi.org/10.1007/s11606-016-3720-4\u003c/li\u003e\n \u003cli\u003eLucas BP, Trick WE, Evans A T, Mba B, Smith J, Das K, et al. Effects of 2- vs 4-Week Attending Physician Inpatient Rotations on Unplanned Patient Revisits, Evaluations by Trainees, and Attending Physician Burnout: A Randomized Trial. JAMA. 2012;308(21): 2199\u0026ndash;2207. https://doi.org/10.1001/jama.2012.36522\u003c/li\u003e\n \u003cli\u003ePanagioti M, Panagopoulou E, Bower P, Lewith G, Kontopantelis E, Chew-Graham C. Controlled Interventions to Reduce Burnout in Physicians: A Systematic Review and Meta-analysis. JAMA Internal Medicine. 2017;177(2): 195\u0026ndash;205. https://doi.org/10.1001/jamainternmed.2016.7674\u003c/li\u003e\n \u003cli\u003eWeidner AKH, Phillips RL, Fang B, Peterson LE. Burnout and Scope of Practice in New Family Physicians. Annals of Family Medicine. 2018;16(3): 200\u0026ndash;205. https://doi.org/10.1370/afm.2221\u003c/li\u003e\n \u003cli\u003eHe Y, Pang Y, Zhang Y, Fielding R, Tang L. Dual role as a protective factor for burnout‐related depersonalization in oncologists. Psycho-Oncology (Chichester, England). 2017;26(8): 1080\u0026ndash;1086. https://doi.org/10.1002/pon.4425\u003c/li\u003e\n \u003cli\u003eShanafelt TD. Enhancing Meaning in Work: A Prescription for Preventing Physician Burnout and Promoting Patient-Centered Care. JAMA. 2009;302(12): 1338\u0026ndash;1340. https://doi.org/10.1001/jama.2009.1385\u003c/li\u003e\n \u003cli\u003eRafferty JP, Lemkau JP, Purdy RR, Rudisill JR. Validity of the Maslach burnout inventory for family practice physicians. Journal of Clinical Psychology. 1986;42(3): 488\u0026ndash;492. https://doi.org/10.1002/1097-4679(198605)42:3\u0026lt;488::AID-JCLP2270420315\u0026gt;3.0.CO;2-S\u003c/li\u003e\n \u003cli\u003eLin CY, Alimoradi Z, Griffiths MD, Pakpour AH. Psychometric properties of the Maslach Burnout Inventory for Medical Personnel (MBI-HSS-MP). Heliyon. 2022;8(2): e08868\u0026ndash;e08868. https://doi.org/10.1016/j.heliyon.2022.e08868\u003c/li\u003e\n \u003cli\u003eLinzer M, Manwell LB, Williams ES, Bobula JA, Brown RL, Varkey AB, et al. Working Conditions in Primary Care: Physician Reactions and Care Quality. Annals of Internal Medicine. 2009;151(1): 28\u0026ndash;36. https://doi.org/10.7326/0003-4819-151-1-200907070-00006\u003c/li\u003e\n \u003cli\u003eShimotsu S, Poplau S, Linzer M. Validation of a brief clinician survey to reduce clinician burnout. Journal of General Internal Medicine. 2015;30(2 Supplement): S79\u0026ndash;S80.\u003c/li\u003e\n \u003cli\u003eShaw E, Oandasan I, Fowler N. (2017). CanMEDS-Family Medicine 2017: A competency framework for family physicians across the continuum. The College of Family Physicians of Canada. 2017. [Accessed June 16/23]. https://portal.cfpc.ca/resourcesdocs/uploadedFiles/Resources/Resource_Items/Health_Professionals/CanMEDS-Family-Medicine-2017-ENG.pdf\u003c/li\u003e\n \u003cli\u003eStaten A. Combatting burnout: a guide for medical students and junior doctors (A. Staten, Ed.). 2019. CRC Press/Taylor \u0026amp; Francis Group.\u003c/li\u003e\n \u003cli\u003eFreudenberger HJ. The staff burn-out syndrome in alternative institutions. Psychotherapy (Chicago, Ill.). 1975;12(1): 73\u0026ndash;82. https://doi.org/10.1037/h0086411\u003c/li\u003e\n \u003cli\u003eCollier R. Physician burnout a major concern. Canadian Medical Association Journal. 2017;189(39): E1236. https://doi.org/10.1503/cmaj.1095496\u003c/li\u003e\n \u003cli\u003eWest CP, Dyrbye LN, Erwin PJ, Shanafelt TD. Interventions to prevent and reduce physician burnout: a systematic review and meta-analysis. The Lancet. 2016;388(10057): 2272\u0026ndash;2281. https://doi.org/10.1016/S0140-6736(16)31279-X\u003c/li\u003e\n \u003cli\u003eEpstein RM, Privitera MR. Doing something about physician burnout. The Lancet. 2016;388: 2216\u0026ndash;2217.\u003c/li\u003e\n \u003cli\u003eKrasner MS, Epstein RM, Beckman H, Suchman AL, Chapman B, Mooney CJ, et al. Association of an Educational Program in Mindful Communication With Burnout, Empathy, and Attitudes Among Primary Care Physicians. JAMA. 2009;302(12): 1284\u0026ndash;1293. https://doi.org/10.1001/jama.2009.1384\u003c/li\u003e\n \u003cli\u003eShanafelt TD, Noseworthy JH. Executive Leadership and Physician Well-being: Nine Organizational Strategies to Promote Engagement and Reduce Burnout. Mayo Clinic Proceedings. 2017;92(1): 129\u0026ndash;146. https://doi.org/10.1016/j.mayocp.2016.10.004\u003c/li\u003e\n \u003cli\u003eLemire F. Combating physician burnout. Canadian Family Physician. 2018;64(6): 480. http://www.cfp.ca/content/64/6/480.abstract\u003c/li\u003e\n \u003cli\u003eRenting N, Raat AN, Dornan T, Wenger-Trayner E, Wal M, Borleffs J, et al. Integrated and implicit: How residents learn CanMEDS roles by participating in practice. Medical Education. 2017;51. https://doi.org/10.1111/medu.13335\u003c/li\u003e\n\u003c/ol\u003e"},{"header":"Tables","content":"\u003cp\u003eTables 1 to 4 are available in the Supplementary Files section.\u003c/p\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"Family Practice, burnout, workload, survey, mental health","lastPublishedDoi":"10.21203/rs.3.rs-4184397/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-4184397/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eBackground\u003c/strong\u003e: Physician burnout is a longstanding issue which has only intensified as a result of the COVID-19 pandemic. Earlier studies indicate that individuals in frontline specialties, such as family medicine, may be more susceptible to burnout, and interventions have primarily targeted reduced workloads and physician autonomy. However, we sought to explore work-life balance in relation to burnout prevention. We theorized that family physicians who participated in multiple clinical roles (e.g., outpatient practice, emergency) and included non-clinical roles (e.g., teaching, administration) within their practice would report lower burnout scores compared to family physicians with singular roles.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMETHODS\u003c/strong\u003e: We utilized a cross-sectional survey, incorporating two validated burnout measures (Maslach Burnout Inventory and MiniZ-2.0), and compared burnout scores to family physician’s self reported number of and hours dedicated to both clinical and non-clinical roles. We surveyed family physicians in Ontario, Manitoba and British Columbia.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eRESULTS\u003c/strong\u003e: Descriptive analysis suggested that as clinical and non-clinical roles increase, burnout scores decline. Correlational analysis showed that as non-clinical roles increase, emotional exhaustion scores decrease. Similarly, as non-clinical hours increase, family physicians reported a more joyful and manageable workplace. \u003cstrong\u003eCONCLUSIONS\u003c/strong\u003e: Our findings lend credence to the notion that the meaning in work, rather than the quantity of work, may be a driving factor in burnout. Thus, physicians should continue to diversify their practice with meaningful clinical and non-clinical activities to help prevent burnout.\u003c/p\u003e","manuscriptTitle":"Exploring Practice Diversity as a Prevention Strategy for Burnout: A Survey of Family Physicians","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2024-07-18 18:26:29","doi":"10.21203/rs.3.rs-4184397/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"f8e3450e-497c-4c09-8f8c-a8f682a5128d","owner":[],"postedDate":"July 18th, 2024","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2024-07-18T18:26:32+00:00","versionOfRecord":[],"versionCreatedAt":"2024-07-18 18:26:29","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-4184397","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-4184397","identity":"rs-4184397","version":["v1"]},"buildId":"qtupq5eGEP_6zYnWcrvyt","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}