This study aimed to identify factors associated with increased levels of burnout in Australian general practice registrars. To the best of our knowledge, this has not been previously explored in the literature. There were several key findings. Emotional exhaustion was demonstrated to occur at higher levels as compared to depersonalisation and personal accomplishment. Associations were noted between burnout and a number of demographic factors. For instance, increasing age was associated with higher levels of burnout within the subscale of personal accomplishment. Increased number of dependants was associated with lower levels of burnout, independent of other factors including number of hours worked. In the adjusted linear regression models, gender was not associated with any of the burnout subscales.
We observed across all ages and genders that emotional exhaustion was the most common subscale which demonstrated moderate to high levels of burnout. This is consistent with the literature which demonstrates that in workplaces where there are high levels of stress such as general practice, emotional exhaustion can be seen as a precursor to depersonalisation and worsening burnout (Houkes et al., 2011). The high demands on cognitive load leads to mental and physical exhaustion, which in turn can lead to depersonalisation as a coping strategy for the exhaustion (Houkes et al. 2011). This is reflected in this study, where emotional exhaustion levels are higher, potentially as a precursor to depersonalisation and worsening personal accomplishment. This gives an opportunity for GP colleges, regional training organisations, and local training practices to work to identify strategies to reduce emotional exhaustion (Houkes et al 2011). This could be developed through emotional regulation training and strategies such as increasing teamwork and reducing external pressures (Hülsheger et al. 2013). This may lead to reduced burnout and increased registrar retention (Cain et al. 2017).
Increasing age was associated with lower personal accomplishment scores, which were independent of other factors investigated as part of this study. A study by Cook et al (2013) discussed personal accomplishment and burnout in General Practice Registrars. They identified that anxiety as a result of clinical uncertainty in patient encounters, and a reluctance to disclose this uncertainty were associated with being at higher risk of burnout (Cook, Doust, Steele 2013). This explanation in the literature may be applicable to our cohort. It may be that GP registrars more senior in age experience increased anxiety and apprehension when facing clinical uncertainty and breadth of knowledge required in general practice. This provides opportunity for further research to identify the cause of this finding and to develop policy and training strategies to better support mature trainees.
Males and females both experienced high levels of burnout in the current study. Within each subscale of emotional exhaustion, depersonalisation and personal accomplishment there were some differences. For instance, females were more likely to experience emotional exhaustion, whereas within the depersonalisation and personal accomplishment subscales there were similar levels of burnout reported across genders. Previous research has attributed increased levels of burnout in females to demands on work life balance and an increased emphasis on parenting and home life(Nair et al. 2017; Verweij et al. 2017). The increased emotional exhaustion levels reported by females in our study may be of concern, given that emotional exhaustion has been identified as a precursor to worsening levels of burnout (Houkes et al. 2011). With more females entering general practice training (Radloff et al. 2019), and higher numbers of females in this study reporting emotional exhaustion, the reasons for this and protective supports available to reduce burnout should be examined.
Children can impact on career significantly, by way of delaying or changing career goals (Hoffman et al. 2020a; Windsor and Auyeung 2006), reducing potential income (Grimshaw and Rubery 2015), and placing increased pressure on work life balance (Ellinas et al. 2018; Sang et al. 2007). However, this study demonstrated that having children was associated with lower levels of burnout, and this was increasingly protective with increased numbers of children. This has also been demonstrated in other careers, where it has been argued that having a career and a family are mutually beneficial in preventing burnout, with a family buffering the impact that workload has on burnout (ten Brummelhuis et al. 2008). This association may have a number of causes, including; that parenting is associated with increased learned resilience, or that registrars who are experiencing lower levels of burnout in training are more likely to plan to increase the size of their family. There are other individual registrar factors which may lead to lower levels of burnout and increased family size, such as home based and external supports, and family size preferences(Farahat FM 2009). This finding points to the diverse intricacies around child rearing during career planning and professional training. It provides an opportunity to do further research into this complexity and examine the interactions between parenting, training demands, workplace supports and provide overarching policies and individual supports to trainees.
Limitation Of Study
The limitations of this study include the inability to determine the return rate; as an annual survey, formal records of the number of invitations sent to GP registrars were not kept limiting the ability to calculate a return rate. The cross-sectional survey design is a limitation in identifying causation. Future research should look at alternate study designs, including prospective cohort designs, to further explore the findings found in this study.