Driving Physician Burnout: Corporate Takeover & Value-Based Care

Summary: A survey of 700 US primary care physicians found burnout much less likely in solo and physician-owned (non-corporate) practices and much more likely with ACOs and other value-based care. Lesson: current health system trends are hazardous to the health of doctors … and thus harm patient care.

Cultural and Structural Features of Zero-Burnout Primary Care Practices, Health Affairs, June 2021, by ST Edwards et al.

From the Abstract: Survey of 715 small-to-medium-size primary care practices in the US.

Compared with high-burnout practices, zero-burnout practices…more commonly were solo [odds ratio 5.3] and clinician owned [odds ratio 2.6], and less commonly had participated in accountable care organizations [odds ratio 0.5] or other demonstration projects [odds ratio 0.6].”

(Note: Odds ratios in brackets from Exhibit 3 of the article. An odds ratio approximates relative risk, so OR=5 means 5 times more likely, and 0.5 means half as likely.)

Comment:

By David Himmelstein, M.D. and Steffie Woolhandler, M.D., M.P.H.

Many studies have documented a growing epidemic of physician burnout, and its deleterious effects on physicians’ quality of life and the quality of patient care. To date most efforts to address burnout have focused on adapting physicians to make them more “resilient”, e.g. through wellness initiatives, yoga classes, or “thank you” gestures (one Boston hospital rewarded house officers for their efforts in staffing COVID-19 ICUs by handing out M&Ms – both plain and peanut – stamped with the hospital’s logo).

This survey of 715 primary care practices suggests that the health care system – not fragile doctors – is the problem.  So-called “value-based care” and the galloping corporate takeover, changes driven by market-oriented health policies and championed by policy wonks, are driving doctors to despair.  Doctors continue to bear responsibility for life and death, but have little control over the pace of their own work, or authority to address the barriers to care that they and their patients routinely encounter.

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