GPs caring for most complex patients at higher risk of burnout

GPs caring for high numbers of patients with multimorbidity are more susceptible to burnout, new research has found.

(Photo: monkeybusinessimages/Getty Images)
(Photo: monkeybusinessimages/Getty Images)

Research from Denmark published in the BJGP, found that rates of burnout were almost twice as high among GPs caring for the highest number of patient with multimorbidity compared with those caring for the lowest number. Multimorbidity was defined as patients having two or more significant long-term conditions.

The researchers suggested that the increased risk of burnout could be related to greater workload, inadequate guidelines related to managing multimorbidity, fragmented specialist care and the lack of additional funding for GPs managing large numbers of patients with complex needs.

They said that improved working conditions in general practice were needed to enable GPs to effectively care for an ageing population - and called for more support for GPs caring for large numbers of people with multiple chronic conditions.

Warnings about the impact of caring for large numbers of patients with multimorbidity come just months after a GMC report warned that half of UK GPs feel unable to cope with their workload. GPonline revealed last year that in England's most underdoctored areas, there are now almost 3,000 patients per full-time equivalent, fully-qualified GP - and that some of these areas have large numbers of older patients.

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For the study, 1,676 Danish GPs completed a survey to assess whether they were burned out, and the findings were combined with data on their patients' physical multimorbidity.

As in the UK, Danish GPs work as independent contractors and nearly all citizens are registered with a practice where they receive free care. The average list size in the country is around 1,600 patients per GP. All the GPs who took part in the study were the equivalent of partners in the UK.

The crude rate of patients with physical multimorbidity was calculated for each practice as the number of patients classified with two or more physical long-term conditions per 100 patients.

Among all 1,676 GPs, 10.1% reached the criteria for full burnout. Among GPs with a rate of patient multimorbidity in the highest quartile, 12.4% were burned out, while in those with a rate of patient multimorbidity in the lowest quartile, 7.3% were burned out.

GP burnout

The researchers pointed out that the study may have underestimated the association between patient multimorbidity and GP burnout because it didn't take account of mental illness and only included patients who had been treated for their condition at a hospital appointment, so therefore excluded those treated solely in primary care.

The research also found that the number of female patients, the number of GPs in the practice and deprivation were not associated with increased likelihood of burnout.

Lead author Anette Fischer Pedersen said: 'We have shown that two observed contemporary trends, namely increased incidence of patient multimorbidity and increased incidence of burnout in GPs, are linked at the individual practice level.

'Our findings call for actions to reduce the future workload from an ageing population. This could involve rethinking the organisation of primary care and creating better working conditions for GPs who must handle increasingly complex health needs of patients with multimorbidity. Otherwise, we might risk the paradox that the patients with the greatest need receive the least treatment.’

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