Burnout Predictors Among Direct Clinical Services Health Care Professionals in Community Health Centers: A Cross-Sectional Study

Abstract

Purpose

Assess burnout prevalence, identify the healthcare professionals experiencing burnout, and identify organizational predictors of burnout in community health centers (CHCs) nationwide.

Approach

In 2022 the Health Resources and Services Administration administered surveys to assess health center workforce well-being among the 1400+ community health centers that it oversees. Our team statistically evaluated the findings to isolate the factors likely to predict burnout among center healthcare professionals.

Setting

Data completed by staff in 694 CHCs.

Participants

Respondents were 52 568 healthcare professionals.

Methods

Chi-squared tests derived homogeneity in burnout among occupations; proportion tests evaluated differences in burnout indicators; and structural equation modeling with latent variables estimated direct and indirect effects of organizational burnout predictors and mediators.

Results

Up to 77% of direct clinical service professionals endorsed at least one symptom of burnout and reported higher burnout rates than management (P < .001). The most significant burnout predictors were engagement (−0.263***), work-life balance (0.281***), workload (0.174***) and professional growth (0.143***). For engagement, a perception of disconnection with the CHC predicted heightened burnout. Work-life balance, workload, and professional growth each had a positive effect on burnout, demonstrating that higher perceived work demands, greater work-life imbalance, and increased professional growth opportunities equated to higher burnout.

Conclusion

Results highlight the need to redesign healthcare delivery models to mitigate burnout, promote provider engagement and enhance workforce well-being.

Keywords

community health centers healthcare workforce burnout

Get full access to this article

View all access options for this article.

References

World Health Organization . QD85 Burnout. ICD-11 for Mortality and Morbidity Statistics. Geneva: WHO; 2024. https://icd.who.int/browse/2024-01/mms/en#129180281. Accessed 11 July 2024.

Maslach

Jackson

. The measurement of experienced burnout. J Organ Behav. 1981;2(2):99-113. doi:10.1002/job.4030020205

Aiken

Lasater

Sloane

, et al. Physician and nurse well-being and preferred interventions to address burnout in hospital practice: factors associated with turnover, outcomes, and patient safety. JAMA Health Forum. 2023;4(7):e231809. doi:10.1001/jamahealthforum.2023.1809

Davidson

Proudfoot

Lee

Zisook

. Nurse suicide in the United States: analysis of the center for disease control 2014 national violent death reporting system dataset. Arch Psychiatr Nurs. 2019;33(5):16-21. doi:10.1016/j.apnu.2019.04.006

Harvey

Epstein

Glozier

, et al. Mental illness and suicide among physicians. Lancet. 2021;398(10303):920-930. doi:10.1016/S0140-6736(21)01596-8

Murthy

. Confronting health worker burnout and well-being. N Engl J Med. 2022;387(7):577-579. doi:10.1056/NEJMp2207252

Lynch

. The Epidemic of Burnout, Depression and Suicide in Medicine: One Doctor’s Story. Melbourne, VIC: The Conversation; 2015. https://theconversation.com/the-epidemic-of-burnout-depression-and-suicide-in-medicine-one-doctors-story-41800. Accessed 8 July 2024.

Hall

Lim

Gale

. Failure to rescue. In: Hall

Shoemaker-Hunt

Hoffman

, et al., eds. Making Healthcare Safer III: A Critical Analysis of Existing and Emerging Patient Safety Practices. Rockville, MD: Agency for Healthcare Research Quality; 2020. https://www.ncbi.nlm.nih.gov/books/NBK555513/. Accessed 30 December 2023.

Wilkinson

Whittington

Perry

Eames

. Examining the relationship between burnout and empathy in healthcare professionals: a systematic review. Burn Res. 2017;6:18-29. doi:10.1016/j.burn.2017.06.003

10.

Van Der

Keijsers

GPJ

Eling

Schaijk

. Work stress and attentional difficulties: an initial study on burnout and cognitive failures. Work Stress. 2005;19(1):23-36. doi:10.1080/02678370500065275

11.

Centers for Disease Control and Prevention . Online Training – Understanding and Preventing Burnout Among Public Health Workers: Guidance for Public Health Leaders: Module 8 – Organizational Approaches to Reducing Burnout Risk. Washington, DC: The National Institute for Occupational Health and Safety; 2022. https://www.cdc.gov/niosh/learning/publichealthburnoutprevention/module-8/outline.html. Accessed 25 March 2025.

12.

Murthy

. Addressing Health Worker Burnout: The U.S. Surgeon General’s Advisory on Building a Thriving Health Workforce; 2022. https://www.hhs.gov/sites/default/files/health-worker-wellbeing-advisory.pdf. Accessed 30 December 2023.

13.

Zhang

. Estimation of differential occupational risk of COVID‐19 by comparing risk factors with case data by occupational group. Am J Ind Med. 2021;64(1):39-47. doi:10.1002/ajim.23199

14.

Nagel

Keeping-Burke

Shamputa

. Concept analysis and proposed definition of community health center. J Prim Care Community Health. 2021;12:215013272110464. doi:10.1177/21501327211046436

15.

Green

Albanese

Shapiro

Aarons

. The roles of individual and organizational factors in burnout among community-based mental health service providers. Psychol Serv. 2014;11(1):41-49. doi:10.1037/a0035299

16.

Hill

Justo

Park

, et al. Pediatric provider and staff burnout in federally qualified community health centers. J Ambul Care Manag. 2023;46(4):265-271. doi:10.1097/JAC.0000000000000472

17.

Graber

Huang

Drum

, et al. Predicting changes in staff morale and burnout at community health centers participating in the health disparities collaboratives. Health Serv Res. 2008;43(4):1403-1423. doi:10.1111/j.1475-6773.2007.00828.x

18.

Jiri

Mangione

. HRSA Health Center Workforce Well-Being National Data Report: Findings From the 2022 HRSA Health Center Workforce Well-Being Survey; 2023. https://data.hrsa.gov/DataDownload/DD_Files/HRSA_Health_Center_Workforce_Well-being_National_Data_Report.pdf. Accessed 17 June 2024.

19.

Agency for Healthcare Research and Quality . Physician Burnout. Rockville, MD: Agency for Healthcare Research and Quality; 2023. https://www.ahrq.gov/prevention/clinician/ahrq-works/burnout/index.html. Accessed 8 July 2024.

20.

Demerouti

Bakker

Vardakou

Kantas

. The convergent validity of two burnout instruments: a multitrait-multimethod analysis. Eur J Psychol Assess. 2003;19(1):12-23. doi:10.1027//1015-5759.19.1.12

21.

SAS On Demand for Academics . Statistical Software [Computer Software]; 2021.

22.

R Foundation for

Statistical Computing. R: A Language and Environment for Statistical 439 Computing. Published online. 2023. https://www.r-project.org/.

23.

Columbia University . Path Analysis. New York, NY: Columbia University; 2024. https://www.publichealth.columbia.edu/research/population-health-methods/path-analysis. Accessed 26 September 2024.

24.

Soper

. Reducing burnout and promoting professional development in the palliative care service. J Hospice Palliat Nurs. 2022;24(3):181-185. doi:10.1097/NJH.0000000000000847

25.

National Council of State Boards of Nursing . Licensure: About Nursing Licensure. Chicago, IL: National Council of State Boards of Nursing; 2024. https://www.ncsbn.org/nursing-regulation/licensure.page. Accessed 8 July 2024.

26.

Horstman

. Underfunded and Overburdened: The Toll of the COVID-19 Pandemic on Community Health Centers. New York, NY: The Commonwealth Fund; 2023. https://www.commonwealthfund.org/blog/2023/underfunded-and-overburdened-toll-covid-19-pandemic-community-health-centers#:∼:text=Despite_their_vital_role%2C_health,everyone_could_receive_lifesaving_care. Accessed 18 November 2024.

27.

Dorman

Raffin Bouchal

. Moral distress and moral uncertainty in medical assistance in dying: a simultaneous evolutionary concept analysis. Nurs Forum. 2020;55(3):320-330. doi:10.1111/nuf.12431

28.

Webster

Baylis

. In: Rubin

Zoloth

, eds. Margin of Error: The Ethics of Mistakes in the Practice of Medicine. London: University Publishing Group; 2000. https://hdl.handle.net/10822/931017. Accessed 18 November 2024.

29.

National Academies of Sciences E and M, National Academy of Medicine, Committee on Systems Approaches to Improve Patient Care by Supporting Clinician Well-Being . Taking Action Against Clinician Burnout: A Systems Approach to Professional Well-Being; 2019. https://www.ncbi.nlm.nih.gov/books/NBK552616/, Accessed 25 May 2024.

30.

Dzau

Kirch

Murthy

Nasca

, eds. National Plan for Health Workforce Well-Being. Washington, DC: National Academies Press; 2024. doi:10.17226/26744

31.

Centers for Disease Control and Prevention . CDC Policy Process. Office of Policy Performance and Evaluation. Atlanta, GA: Centers for Disease Control and Prevention; 2022. https://www.cdc.gov/policy/paeo/process/index.html. Accessed 8 July 2024.

32.

National Academy of Medicine . NAM Changemaker Campaign for Health Workforce Well-Being. Washington, DC: National Academy of Medicine. https://nam.edu/initiatives/clinician-resilience-and-well-being/change-makers/. Accessed 8 July 2024.

33.

National Academy of Medicine . National Plan for Health Workforce Well-Being: Priority Area 4. Address Compliance, Regulatory, and Policy Barriers for Daily Work. New York, NY: National Academy of Medicine. https://nam.edu/wp-content/uploads/2024/03/NAM_HWWB-Day_policymaker-factsheet_exported-by-Burness.pdf. Accessed 8 July 2024.

Supplementary Material

Please find the following supplemental material available below.

For Open Access articles published under a Creative Commons License, all supplemental material carries the same license as the article it is associated with.

For non-Open Access articles published, all supplemental material carries a non-exclusive license, and permission requests for re-use of supplemental material or any part of supplemental material shall be sent directly to the copyright owner as specified in the copyright notice associated with the article.

0.00 MB

0.48 MB