Physician burnout is a serious concern, with a 2014 survey citing the percentage of US physicians experiencing burnout as 54.4%.1 A recent study published in the Journal of the American Board of Family Medicine found that practice size can play a role in whether or not a physician experiences burnout.2

Donna Shelley, MD, MPH, from the New York University School of Medicine, and colleagues conducted a cross-sectional analysis of data collected from 235 healthcare providers who practiced in 174 small, independent primary care practices in New York City. 

Survey data were collected as part of the HealthyHearts NYC trial. The surveys assessed burnout with a single item that had been validated against the Maslach Burnout Inventory: “Using your own definition of burnout, please indicate which of the following statements best describes how you feel about your situation at work.” Optional answers included showing no symptoms of burnout, feeling under stress and less energetic but not burned out, and showing definite symptoms of burnout.

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Other survey items included those assessing practice characteristics, such as the number of providers, medically underserved area designation, patient-centered medical home status, patient panel size, and patient demographics. There were also items covering Change Process Capacity Questionnaire use and adaptive reserve (to measure the nature of leadership within a practice). These were measured alongside the rate of burnout in an attempt to discover correlations between factors.

Results showed that of the providers, 204 were physicians and 31 were nurse practitioners or physician’s assistants. Of the small independent practices, 66.9% were solo provider practices. Across the total surveyed providers, 13.5% reported burnout to some degree. Although more than 10% of the providers reported burnout, the overall number was lower among the providers working at small, independent practices in New York City, compared with burnout rates among physicians surveyed in previous studies.

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One possible reason for this is that solo practices allow more work control and autonomy, reducing burnout levels. The data also showed that a practice with a higher adaptive reserve score was associated with lower burnout odds. This is in line with findings from the National Demonstration Project, which found that sites that were more successful in transforming practices had a greater capacity for learning and development within the organization.3

The researchers found that adaptive reserve may be an important factor in physician burnout. To this end, they suggest that physicians in primary care practices focus on strengthening their organization’s capacity for change, such as communication, innovation, and leadership support.

There were several limitations to the study, including that the data analyzed came solely from practices in New York City, and that missing values were filled using multiple imputations when alternative data sources were unavailable. The investigators concluded that future research is necessary to better understand the relationships between organizational and individual factors and how these have an impact on small independent practices.


  1. Shanafelt TD, Hasan O, Dyrbye LN, et al. Changes in burnout and satisfaction with work-life balance in physicians and the general US working population between 2011 and 2014. Mayo Clin Proc. 2015;90(12):1600-1613.
  2. Bletcher B, Jiang N, Cleland C, Berry C, Ogedegbe O, Shelley D. Correlates of burnout in small independent primary care practices in an urban setting. J Am Board Fam Med. 2018;31(4):529-536.
  3. Nutting PA, Crabtree BF, McDaniel RR. Small primary care practices face four hurdles—including a physician-centric mindset—in becoming medical homes. Health Aff (Millwood). 2012;31(11):2417-2422.