Associations between burnout and career disengagement factors in general practitioners: A path analysis

Christos Grigoroglou^1,2*Mark Hann^1,3,4Alexander Hodkinson^1,4,5Salwa Zghebi^1,4Evangelos Kontopantelis^1,4,6Darren Ashcroft^1,4,5,7Carolyn Chew-Graham^8,9Rupert Payne^10,11Paul Little^12,13Simon de Lusignan^14,15Anli Yue Zhou^1,4Aneez Esmail^1,4Maria Panagioti^1,4

• ¹The University of Manchester, Manchester, United Kingdom
• ²Manchester Centre for Health Economics, Manchester, United Kingdom
• ³Centre for Primary Care and Health Services Research, University of Manchester, Manchester, England, United Kingdom
• ⁴Division of Population Health, Health Services Research and Primary Care, School of Health Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, England, United Kingdom
• ⁵National Institute for Health and Care Research Greater Manchester Patient Safety Research Collaboration, Manchester, United Kingdom
• ⁶Division of Informatics, Imaging and Data Science, School of Health Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, England, United Kingdom
• ⁷Centre for Pharmacoepidemiology and Drug Safety, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, England, United Kingdom
• ⁸Keele University, Keele, United Kingdom
• ⁹School of Medicine, Faculty of Medicine and Health Sciences, Keele University, Newcastle-under-Lyme, United Kingdom
• ¹⁰University of Exeter, Exeter, England, United Kingdom
• ¹¹Exeter Collaboration for Academic Primary Care, Exeter, United Kingdom
• ¹²University of Southampton, Southampton, Hampshire, United Kingdom
• ¹³Primary Care Research Centre, Faculty of Medicine, University of Southampton, Southampton, Hampshire, United Kingdom
• ¹⁴University of Oxford, Oxford, England, United Kingdom
• ¹⁵Nuffield Department of Primary Health Care Health Sciences, Medical Sciences Division, University of Oxford, Oxford, England, United Kingdom

Background: Burnout is associated with career disengagement in General Practitioners (GPs), yet understanding the mechanisms underpinning this association remains incomplete.Objective: This study examined pathways of the association between burnout and career disengagement factors among GPs.Methods: An 11-item online questionnaire included validated abbreviated measures of burnout outcomes (single items on emotional exhaustion and depersonalisation), career disengagement factors (intention to quit patient care, work-life balance, presenteeism, job satisfaction) and demographics was distributed to a random sample of GPs in England in December 2019 -April 2020.. Correlations between burnout outcomes and disengagement factors were calculated, followed by path analysis using a generalised structural equation model to model directional relationships between the burnout outcomes and the survey variables.Results: 351 GPs from 57 practices completed the questionnaire. Up to 1-in-4 GPs (22.5%) experienced emotional exhaustion while up to 1-in-3 (27.4%) experienced depersonalisation on a weekly basis. 1-in-3 (33.3%) expressed moderate to high intention to quit patient care within the next five years, 1-in-5 (18.8%) reported job dissatisfaction, 2-in-5 (40.7%) indicated poor work-life balance and up to 1-in-2 (27.4%) reported presenteeism over the past year. In path analysis, intention-to-quit had significant direct associations with both job satisfaction and burnout as well as significant indirect associations (via burnout) with work-life balance and presenteeism. GP demographics were excluded from the path analysis because they exhibited very weak correlations with dimensions of burnout and work engagement factors.These findings highlight the urgent need for interventions and policies that target burnout and improve job satisfaction to retain GPs. Additionally, improving work-life balance and reducing presenteeism can serve as effective early preventative measures for reducing burnout and job dissatisfaction, and in turn, retaining GPs.