Panel Fullness, Burnout, and Intention to Leave Among Veterans Health Administration Primary Care Practitioners

Importance: Primary care practitioners (PCPs) experience high levels of burnout despite mitigation efforts. The foundational nature of primary care in the US health care system obligates a better understanding of the root causes of burnout among PCPs. Objective: To determine whether an association exists between patient panel fullness and PCP burnout and intention to leave. Design, Setting, and Participants: In this cross-sectional study, annual Veterans Health Administration data from 2022 to 2024 were reviewed for primary care panel fullness, support staffing, and clinic characteristics. Participants included all PCP (physicians, nurse practitioners, and physician assistants) respondents to the Veterans Administration (VA) All Employee Survey between 2022 and 2024. Main Outcomes and Measures: The primary outcomes were PCP burnout and intention to leave the VA derived from responses to the annual All Employee Survey. Data were aggregated across 139 facilities and analyzed using cross-sectional and year-to-year change regression models. Results: The study had 15 856 survey respondents across 139 medical centers over 3 years, with response rates of 69.9% in 2022, 74.3% in 2023, and 74.1% in 2024. Of them, 16.4% were younger than 40 years, 26.5% were 40 to 49 years of age, 32.6% were 50 to 59 years, and 20.8% were 60 years or older; 54.2% self-reported being female. Across that time, the mean (SD) burnout rate for PCPs was 55.2% (12.6%), and it was 31.9% (13.2%) for intention to leave the VA. Panel fullness increased from 86.3% in 2022 to 92.8% in 2024. In cross-sectional models, panel fullness was associated with higher rates of burnout (odds ratio [OR], 1.07 [95% CI, 1.00-1.13]) and intention to leave (OR, 1.09 [95% CI, 1.01-1.18]). Year-to-year increases in panel fullness were associated with higher intention to leave (OR, 1.13 [95% CI, 1.01-1.25]), as was prior year panel fullness (OR, 1.19 [95% CI, 1.07-1.33]). Support staff per PCP ratio was associated with higher burnout (OR, 1.32 [95% CI, 1.10-1.58]). Conclusions and Relevance: In this cross-sectional study of PCPs at the VA, increased patient panel fullness was associated with increased PCP burnout and intention to leave. These findings suggest that organizations seeking to increase primary care capacity should weigh the potential downsides of increasing patient panel fullness or capacity.