Over the last several decades, the amount of control that physicians have over their work environments has slowly eroded, a phenomenon that has taken place for a number of reasons. 

But irrespective of the cause, the results are clear: autonomy and flexibility are increasingly rare commodities for practicing physicians, and a study published in the Annals of Internal Medicine has found that lack of control can be directly related to physicians’ burnout levels and their intent to leave their jobs or reduce hours.

“With these shifts, physicians often feel treated as a unit of productivity to be manipulated and afforded little control over their work environment,” says the study, which was co-written by Christine Sinsky, MD, vice president of professional satisfaction at the AMA.

After surveying more than 2,100 physicians in 2022 and 2023, the study found a relationship between burnout and poor control over patient load, team composition, workload, clinical schedule and matters for which the physician was held accountable. Physicians who reported not having enough control over their patient loads and workloads were also more likely to say that they were going to reduce their hours.

Of the survey respondents, 61.4% said they had enough control over their patient loads, 60.6% said they had enough control over membership of their clinical team and 61.3% said they had enough control over their workloads. Almost half—49% of the physicians—reported that they had enough control over hiring of staff and 74.6% said they had enough control over their clinical schedules. Of those who answered the survey, 58.3% said they had enough authority or autonomy over the matters for which they were held accountable.

While the authors pointed out that the study could not determine causation, the evidence was strong that there was a relationship between the studied factors. 

The study’s authors argued that job satisfaction has never just been about money for the vast majority of physicians. They need more to be happy and productive in their jobs, which can be demanding and stressful but also rewarding when the conditions are right.

“Intrinsic motivators, such as autonomy, mastery and purpose, have been shown to be more powerful for physicians than extrinsic motivators, such as salary, and are associated with higher professional satisfaction and lower burnout,” the study says. 

As the leader in physician well-being, the AMA is reducing physician burnout by removing administrative burdens and providing real-world solutions to help doctors rediscover the Joy in Medicine™.

Physician burnout—though down from its historic high in 2021 during the COVID-19 public health emergency—remains an epidemic in the U.S. From the number of physicians leaving their jobs or reducing their hours to patient satisfaction and the care they receive, burnout affects virtually every aspect of health care.

The study’s authors contended that its results show that physician practices and health systems might be able to ameliorate burnout—and hence, its damaging effects—by giving physicians more control over their jobs and workdays, especially over matters for which they ultimately will be held responsible.

“Providing control over these aspects of practice may seem at odds with organizational initiatives to standardize practice operations, including scheduling and workflows,” the study says. “It is imperative, however, that organizations find the right balance between standardization and customization/flexibility.”

The study says the reductions in autonomy and control of physicians over their work “has been driven by many forces including: the move from physician practice ownership to employment, the application of an industrial approach favoring standardization over customization, and cultural changes in the relationship between organizations and their physicians with a shift toward commodification, measurement and culpability.”

Burnout, and the resulting turnover, among physicians can cost organizations significant amounts of money. Depending on a variety of factors, replacing a physician who departs their job can mean anywhere from $500,000 to $1 million or more in lost revenue. The AMA provides a calculator to see just how much it’s costing your organization to replace its lost physicians.

While some health system leaders and executives may believe that giving more control to physicians would be expensive, the alternative is even costlier, wrote the study’s authors.

Providing work control and influence “may decrease the likelihood of physicians experiencing burnout, reducing clinical work hours or leaving to pursue more control elsewhere, thus preserving access for patients, ensuring continuity of care and reducing recruitment/replacement costs,” says the study. “These findings may be critical to organizational and societal efforts to maintain an adequate physician workforce.”

But it’s not just about giving physicians more autonomy. More must be done to turn the tide on burnout.

“Ensuring adequate control over the clinical work environment should be considered one component of a holistic strategy to reduce burnout and retain physicians,” the study’s authors wrote. “Reductions in burnout and turnover, in turn, have the potential to ensure adequate access to care and foster continuity and quality.”

AMA STEPS Forward^® open-access toolkits offer innovative strategies that allow physicians and their staff to thrive in the new health care environment. These resources can help you prevent burnout, create the organizational foundation for joy in medicine and improve practice efficiency. 

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