Health Workforce Brief Autonomy, Satisfaction and Physician Burnout Debra Street & Jeralynn Cossman INTRODUCTION AND BACKGROUND Burnout is higher among physicians than among other professionals, plaguing some physicians from the residency phase of their careers (Shanafelt et al. 2002; Eckleberry-Hunt et al. 2009). Physician burnout is an occupational hazard, a syndrome that includes depersonalization (diminished capacity to relate to patients, family, and friends), emotional exhaustion, and a reduced sense of accomplishment (Shanafelt, et al. 2002; Spickard et al., 2002). Stress and burnout are a challenge for maintaining an optimally healthy and effective physician workforce, particularly if the combination of patient needs and insufficient physician supply push some practitioners past reasonable practice limits. Research on the profession links satisfaction and physician autonomy (Schneider 1998; Konrad et al, 1999; Landon, Reschovsky and Blumenthal, 2003). Career satisfaction reflects both the enjoyment and sense of accomplishment physicians experience in their daily practice of medicine and a holistic perspective on an entire career in a medical specialty. Professional autonomy reflects the capacity for physicians to practice medicine as they prefer (Warren, Weitz and Kulis 1998; Mello et al. 2004), consistent with medical training and professional ethics, free from third party interference. While individual characteristics certainly matter, contextual circumstances also influence physicians’ sense of satisfaction and autonomy, and ultimately, levels of stress they may experience in their medical practices. When stress leads to burnout, it creates problems for individual physicians and for the physician workforce more generally. Burnout may contribute to lower quality patient care (Freeborn 2001) and, more broadly, the size of the physician workforce, since stress may push physicians to leave the profession (Steiger 2006). The evolving delivery of modern health care has challenged physician autonomy as third party actors (such as insurance companies and government agencies) have increased power to intervene in medical decision-making (Light and Levine 1988; Williams et al. 2002). Without a doubt, such changes in power sharing are a stressor for at least some physicians. Medical practice management and workload particulars also shape physician morale and satisfaction (Huby et al. 2002; Jensen et al. 2008) and the sense of fulfillment physicians derive from their work. Physicians who resent third party incursion into their medical practice are at high risk of burnout. Similarly, physicians experiencing greater satisfaction from their medical careers likely have lower levels of stress compared to dissatisfied physicians, who may be at risk for higher levels of stress and burnout. Therefore, a clearer understanding of the relationships among autonomy, satisfaction and burnout is important. DATA AND METHODS A validated single measure of burnout (Rohland, Kruse and Rohrer, 2004) on the 2007/08 MSMD survey asked the physician respondents to: “Please choose the single item that most closely represents how you feel: (1) I enjoy my work. I do not feel burned out. (2) Occasionally I am under stress, and I don’t always have as much energy as I once did. But, I don’t feel burned out. (3) I am definitely burning out and have one or more symptoms of burnout, such as physical or emotional exhaustion. (4) The symptoms of burnout that I’m experiencing won’t go away. I think about frustrations at work a lot. Or (5) I feel completely This is the final brief in a series of four Mississippi Center for Health Workforce Research Briefs on physician burnout. Data are from the Mississippi Workforce Study (2007/08 MSMD); over 1400 doctors licensed to practice in Mississippi (2006-07) responded to the 2007/08 MSMD survey. Data from physicians in active practice involving direct patient care who answered the questions on burnout (N=636) are analyzed in this brief.