By Ellen Feldman, MD
Synopsis: This cross-sectional study of more than 2,000 physicians from diverse healthcare organizations found that reduced control over specific aspects of practice — such as patient load, clinical hours, and overall workload — was significantly associated with not only higher levels of burnout, but also increased intentions to reduce clinical hours or leave practice altogether.
Source: Sinsky CA, Brown RL, Rotenstein L, et al. Association of work control with burnout and career intentions among U.S. physicians: A multi-institution study. Ann Intern Med. 2025;178(1):20-28.
Consider the pressures of a typical day in primary care: a tightly packed schedule, unexpected staffing shortages, and the unrelenting demands of electronic health records (EHRs). These challenges, while familiar, may have deeper implications than simply adding stress; they could influence the trajectory of a career.
A recent cross-sectional study of 2,339 physicians employed by geographically and socioeconomically diverse healthcare organizations explored the critical relationship between workplace control and physician well-being. Building on prior research that identified a connection between greater control over work and improved provider satisfaction, Sinsky et al sought to dissect this relationship further.1,2 Their investigation focused on specific aspects of workplace control — such as autonomy over patient load, team composition, clinical schedule, and workload — to identify which factors are most closely tied to burnout and career intentions.
The data for this study came from a large body of information collected by healthcare systems participating in the American Medical Association (AMA) Organizational Biopsy, a survey tool that is offered to organizations to measure and support the well-being of their staff.3 Sinsky et al extracted specific subsets of data, including responses to the Mini Z assessment to measure emotional exhaustion (a component of burnout), along with other validated tools that gauged physician intent to reduce clinical hours or leave clinical practice within two years.
Physicians were asked to assess their perceived control across six domains: patient load, team composition, hiring of staff, clinical schedule, workload, and autonomy over areas of accountability. The findings revealed that adequate control over these key domains varied considerably: 61.4% of respondents reported sufficient control over their patient load, 60.6% over team composition, 74.6% over their clinical schedule, and only 49% over hiring decisions. Furthermore, just 58.3% reported adequate control over their workload, while 61.3% felt they had sufficient authority over areas of accountability.
Burnout, broadly defined as a condition caused by workplace stress characterized by emotional exhaustion, detachment, and a sense of reduced professional efficacy or power, was a central focus of this study.4 The Mini Z measure of emotional exhaustion, widely perceived as a proxy for burnout, was used in this study as such.5 A multivariable analysis adjusted for demographic and professional characteristics demonstrated strong associations between burnout, intention to change level of clinical practice, and poor control over specific domains. For instance:
- Physicians reporting poor control over patient load had 1.35 times the odds of experiencing burnout compared to those reporting adequate control (95% confidence interval [CI], 1.04-1.75).
- Poor control over team composition increased the odds of burnout even more, with an odds ratio of 1.66 (95% CI, 1.30-2.12).
- Lack of influence over workload presented the highest risk of burnout, with an odds ratio of 3.83 (95% CI, 2.99-4.90). This same group was 1.40 times more likely to plan to reduce clinical hours or leave their current practice in the next two years (95% CI,1.08-1.83).
Notably, while control over hiring decisions did not significantly predict burnout, inadequate influence in this area was associated with a 1.61 times higher risk of planning to leave their current practice (95% CI, 1.18-2.19).
Commentary
This study situates these findings within the broader context of systemic changes in healthcare. The work life of a physician historically has been stressful, with high-stakes decision-making and urgent demands being common. But over recent decades, physicians have moved from independent practice ownership to employment within large healthcare systems. This shift has been accompanied by trends emphasizing standardization, such as uniform scheduling templates and tightly controlled operational workflows. While these measures may attempt to enhance efficiency, they often erode physician autonomy, which has been central to professional satisfaction.6
One key challenge highlighted by this study is the pervasive burden of EHRs. Originally implemented to streamline care and improve documentation, EHRs have instead shifted tasks previously handled by administrative staff, such as order entry, documentation, and data collections, to physicians. Although EHRs promise efficiency, their implementation often has introduced new burdens, creating a disconnect between their intended benefit and practical impact. Many physicians feel the additional workload detracts from time spent on patient care and contributes to a sense of diminished control. Practices wanting to address this may consider investing in clerical support or optimizing EHR workflows to mitigate these burdens.6
It is worth noting that the database for this study was drawn from organizations that opted to participate in the AMA Organizational Biopsy. As previously noted, this is a tool designed to measure and enhance staff well-being.3 This voluntary participation suggests these organizations were, at baseline, open to self-examination and potentially interested in investing in supporting their workforce. It is not unreasonable to infer that the morale and workplace conditions of physicians in organizations that chose not to engage in such initiatives may be even more concerning.
These non-participating organizations might represent environments with less emphasis on physician well-being or fewer resources dedicated to addressing systemic issues, which could exacerbate burnout and career dissatisfaction among their staff.
The implications of this are significant. If the data from organizations committed to improvement already reveal high rates of burnout and dissatisfaction tied to limited workplace control, the reality for physicians in less supportive settings likely is worse. This underscores the need for broader adoption of tools like the AMA Organizational Biopsy across healthcare systems, coupled with actionable steps to address identified gaps. By making provider well-being a universal priority rather than an elective focus, the healthcare industry can move toward more sustainable solutions for its workforce.
What can an individual provider do? While systemic changes are essential, the findings from this study suggest practical steps individual physicians and practice teams can take to enhance workplace satisfaction and resilience:
- Advocate for change: Engage with leadership to highlight specific areas where increased control or flexibility would enhance efficiency and morale. For example, propose adjustments to scheduling templates or request greater input into team composition.
- Prioritize delegation: Maximize the use of care teams by redistributing non-clinical tasks, freeing up time for patient-centered activities.
- Foster peer support: Develop a culture of collaboration and mutual support within your practice. Regular team check-ins or informal peer groups can provide a forum for sharing challenges and solutions.
- Use AMA resources: The AMA’s Organizational Biopsy (providing the parent database for this study) and other tools offer structured ways to assess and improve workplace conditions.
This comprehensive study highlights the direct and profound link between workplace control and physician well-being. By addressing these systemic shortcomings at both the individual and organizational levels, healthcare leaders can improve not only physician satisfaction, but potentially patient care outcomes. These findings remind us that fostering autonomy and trust in the clinical setting is not merely an operational consideration — it is a professional and moral imperative to sustain the heart of medicine.
Ellen Feldman, MD, works for Altru Health System, Grand Forks, ND.
References
- Brossoit RM, Crain TL, Hammer LB, et al. Associations among patient care workers’ schedule control, sleep, job satisfaction and turnover intentions. Stress Health. 2020;36(4):442-456.
- Padmanabhan S. The impact and locus of control on workplace stress and job satisfaction: A pilot study on private-sector employees. Curr Res Behav Sci. 2021;2:100026.
- American Medical Association. AMA Physician Well-Being Program. Updated Oct. 31, 2024. https://www.ama-assn.org/practice-management/physician-health/ama-physician-well-being-program
- World Health Organization. Burn-out an “occuptational phenomenon:” International Classification of Diseases. Published May 28, 2019. https://www.who.int/news/item/28-05-2019-burn-out-an-occupational-phenomenon-international-classification-of-diseases
- Linzer M, McLoughlin C, Poplau S, et al; AMA-Hennepin Health System (HHS) Burnout Reduction Writing Team. The Mini Z Worklife and Burnout Reduction Instrument: Psychometrics and clinical implications. J Gen Intern Med. 2022;37(11):2876-2878.
- The Physicians Foundation. Examining physician, resident, and student wellbeing and impact of the current healthcare landscape. Published 2024. https://physiciansfoundation.org/research/examining-physician-resident-and-student-wellbeing-and-impact-of-the-current-healthcare-landscape/
This cross-sectional study of more than 2,000 physicians from diverse healthcare organizations found that reduced control over specific aspects of practice — such as patient load, clinical hours, and overall workload — was significantly associated with not only higher levels of burnout, but also increased intentions to reduce clinical hours or leave practice altogether.
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