Burnout in French General Practitioners: A Nationwide Prospective Study

Background: We aimed to evaluate the prevalence of burnout among French general practitioners in private practice and to study the risk and protective factors of burnout. Methods: A nationwide cross-sectional study was conducted with French GPs working in a private practice in France who were asked to fulfil an internet questionnaire. We used the secure internet application REDCap®. Exclusion criteria were only working in a hospital, substitute doctors, and internship students. There was a putative sample size of 88,886 GPs. We retrieved the Maslach Burnout Inventory (MBI), occupational characteristics (type of installation, emergency regulated shifts, night shifts, university supervisor, weekly hours worked, seniority), and personal characteristics such as age, gender, marital status, and number of children. Results: We included 1926 GPs among the 2602 retrieved questionnaires. A total of 44.8% of French liberal GPs were experiencing burnout, with 4.8% (95%CI 3.9–5.9%) experiencing severe burnout. The risk factors of severe burnout were male gender (RR = 1.91, 95%CI 1.15–3.16), working in a suburban area (5.23, 2.18–12.58), and having more than 28 appointments per day (1.95, 1.19–3.19). Working more than 50 h weekly showed a tendency to increase the risk of severe burnout (1.55, 0.93–2.59, p = 0.095), with a significant increase in the risk of low and moderate burnout (1.31, 1.02–1.67 and 1.86, 1.34–2.57, respectively). Protective factors were mainly resident training, which decreased the risk of both low, moderate, and severe burnout (0.65, 0.51–0.83; 0.66, 0.48–0.92; and 0.42, 95%CI 0.23–0.76, respectively). Performing home visits decreased the risk of severe burnout (0.25, 0.13–0.47), as did group practice for intermediate level of burnout (0.71, 0.51–0.96). Conclusion: GPs are at a high risk of burnout, with nearly half of them in burnout, with burnout predominantly affecting males and those between the ages of 50 and 60 years old. The main risk factors were a high workload with more than 28 appointments per day or 50 h of work per week, and the main protective factors were related to social cohesion such having a teaching role and working in a group practice with back-office support.

Exploring the Nature of Business Strategy Change for Mental Health Practices in the Age of COVID-19

The Convergence Lab (TCL), a mental health medical group practice that provides group and individual therapy for its adult clients. TCL is a 5-year old organization with five (5) clinicians inclusive of and one (1) full-time office manager and 5 clinicians are full time staff. As a result of COVID-19, TCL has experienced an 75% decrease in revenue since patients are unable to complete their appointments in person. The paper examines how one mental health medical group practice used a management consultant to help the practice change its business strategy to respond to COVID-induced business challenges using automation and technology driven strategic approaches. This inquiry uses organizational development action research intervention and a content analysis of the literature to create real-world solutions that will have value to scholar practitioners that are doing applied research to help similar organizations that are challenged to respond to the global pandemic.

Changes in Physician Telemedicine Use during COVID-19: Effects of Practice Setting, Demographics, Training, and Organizational Policies

Telemedicine use increased during the COVID-19 pandemic, but uptake was uneven and future use is uncertain. This study, then, examined the ability of personal and environmental variables to predict telemedicine adoption during the COVID-19 pandemic. A total of 230 physicians practicing in the U.S. completed questions concerning personal and environmental characteristics, as well as telemedicine use at three time points: pre-pandemic, during the pandemic, and anticipated future use. Associations between use and characteristics were determined to identify factors important for telemedicine use. Physicians reported that telemedicine accounted for 3.72% of clinical work prior to the pandemic, 46.03% during the pandemic, and predicted 25.44% after the pandemic ends. Physicians within hospitals reported less increase in telemedicine use during the pandemic than within group practice (p = 0.016) and less increase in use at hospitals compared to academic medical centers (p = 0.027) and group practice (p = 0.008). Greater telemedicine use was associated with more years in practice (p = 0.009), supportive organizational policies (p = 0.001), organizational encouragement (p = 0.003), expectations of greater patient volume (p = 0.003), and perceived higher quality of patient care (p = 0.032). Characteristics such as gender, number of physicians, and level of telemedicine training were not significant predictors. Organizations interested in supporting physicians to adopt telemedicine should encourage its use and create policies supporting its use. More senior physicians had a greater degree of telemedicine uptake, while training programs did not predict use, suggesting that efforts to develop telemedicine competency in younger physicians may be ineffective and should be re-examined.

Operations Management in Ambulatory Care in Switzerland

Practice efficiency is influenced by its operations management. We aim at studying implementation of operations management in Swiss medical practices and we develop a dashboard that allows controlling and managing resources. To study operations management and relevant indicators in ambulant care, we distributed questionnaires by e-mail and conducted 6 interviews. In collaboration with a group practice, we collected requirements regarding a dashboard for operations management, developed a mockup and finally a prototype. This prototype was deployed and implemented in daily routine. From the assessments we learned that practice information systems (PIS) are not sufficiently supporting production planning and control. Relevant indicators include processing time per patient or waiting time for quantifying efficiency and identify potential improvements in production. Within 5 weeks of implementation of our dashboard in a group practice, we learned that calculating indicators and support of operations management by means of a dashboard is well appreciated by practice employees. Indicators are considered extremely useful for operations management.