Association of facility‐ and hospital medicine group‐level characteristics on the impact of burnout among hospitalists in the Veteran's Health Administration

BACKGROUND: Burnout is highly prevalent in hospital medicine (HM). Few studies have examined the impact of hospitalist burnout within the Veteran's Health Administration (VHA) or how the practice environment and work characteristics impact burnout. OBJECTIVES: Describe associations between facility- and HM group-level characteristics and perceived burnout. METHODS: We surveyed HM leaders at 121 VHA acute care facilities on workload structure, staffing models, and experiences. Our primary outcome, leader's perception of the impact of burnout, was rated on a 5-point Likert-type scale and dichotomized for moderate/high/severe impact. RESULTS: Overall, 117 HM groups (97%) had complete information. Facility-level characteristics associated with higher odds of moderate/high/severe leader-perceived impact of burnout included a higher number of operating beds (odds ratio [OR] per 10 additional beds 1.09, 95% confiidence interval [CI]: 1.02-1.18), higher mean daily admissions (OR per 10 additional admissions 1.06, 95% CI: 1.01-1.12) and working at a higher complexity facility (OR: 2.63, 95% CI: 1.14-6.25). Group-level factors included having any vacant physician position (OR: 35.5, 95% CI: 7.11-345.5) and each additional 10% increase in vacant HM physician positions (OR: 1.52, 95% CI: 1.01-2.48). Secondary analysis showed increased association between facility complexity, maximum patient load per team, and physician vacancies with high/severe leader-perceived impact of burnout. CONCLUSIONS: Facility-level factors such as hospital complexity and number of operating beds were associated with the HM leader's perceived impact of burnout, as were group-level characteristics, including maximum patient load per team and physician staffing vacancies. Group-level characteristics may be amenable to modification, providing potential opportunities for VHA leaders to address these factors.