ArticleFamily practice2014
Is burnout associated with referral rates among primary care physicians in community clinics?
Article in Family practice, 2014. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 32 papers, 3 of them syntheses that pooled it.
What it found
Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.
The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.
Who cites it
32 citing papers in PubMed, 3 syntheses or guidelines pooled it.
- Prevalence of Burnout in Healthcare Specialties: A Systematic Review Using Copenhagen and Maslach Burnout Inventories.Medical science monitor : international medical journal of experimental and clinical research · 2022Pooled it
- Burnout among healthcare providers in the complex environment of the Middle East: a systematic review.BMC public health · 2019Pooled it
- Pooled it
- Yoga complemented cognitive behavioral therapy on job burnout among teachers of children with autism spectrum disorders.Medicine · 2021Trial
- Observational
- The effect of general practitioners' sex and age on patients' healthcare utilization: a Norwegian registry study.Research in health services & regions · 2026Article
- Article
- Loneliness among family medicine providers and its impact on clinical and teaching practice.Scientific reports · 2025Article
- Has cross-level clinical coordination changed in the context of the pandemic? The case of the Catalan health system.BMC health services research · 2024Article
- Burnout among family medicine residents: a cross-sectional nationwide study.Israel journal of health policy research · 2024Article
- Psychometric properties of Clinical Learning Environment Inventory and its association with Moroccan nursing students' satisfaction: A PLS-SEM approach.Belitung nursing journal · 2023Article
- "Going through the motions": A qualitative exploration of the impact of emergency medicine resident burnout on patient care.AEM education and training · 2022Article
- Validity and Reliability of Cultural Mix Coping Inventory for Stressful Situations among Healthcare Professionals in Ghana Amidst COVID-19.International journal of environmental research and public health · 2022Article
- Association of organizational and patient behaviors with physician well-being: A national survey in China.PloS one · 2022Article
- Effect of burnout among physicians on observed adverse patient outcomes: a literature review.BMC health services research · 2021Review
- A Bespoke Electronic Health Record for Epilepsy Care (EpiToMe): Development and Qualitative Evaluation.Journal of medical Internet research · 2021Article
- Pediatric subspecialty workforce: undersupply or over-demand?Pediatric research · 2020Article
- Person-centred and efficient care delivery for high-need, high-cost patients: primary care professionals' experiences.BMC family practice · 2020Article
- Associations Between Burnout and Practice Organization in Family Physicians.Annals of family medicine · 2019Article
- Increasing workload in Norwegian general practice - a qualitative study.BMC family practice · 2019Article
Corrections and comments
PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.
Authors and funding
6 authors.
Funding
No grant is acknowledged in the PubMed record.
Abstract
backgroundThere is little empirical research examining the effects of burnout on objective measures of primary care physicians' behaviour in the medical encounter.
objectivesWe studied possible associations between primary care physicians' burnout and the rates of referrals. We conceptualized referral rate as a negative outcome of burnout because high and unnecessary referral rates incur extra costs to health care systems.
methodsIn this cross-sectional study, 136 primary care physicians in one district of one Israeli health maintenance organization (HMO) completed the Maslach Burnout Inventory in the presence of an interviewer. Data on each physician's objective workload and number of referrals for high- and low-cost imaging tests, specialist clinics and treatments by nurses were collected from the HMO's databases.
resultsDue to high correlations between referral rate indicators, a Confirmatory Factor Analysis revealed one factor: 'referrals for diagnostic tests and specialist clinics'. Path Analysis using Structural Equation Modelling explained a total of 18.1% of referral rate variance, with board-certified specialist mostly associated (β = 0.31, P < 0.01), followed by burnout (β = 0.20, P < 0.05) and objective workload (β = 0.18, P < 0.05).
conclusionsIn this preliminary investigation, we found that referral rates for diagnostic tests and specialist clinics increased independently for board-certified specialists (compared with GPs), for those with higher burnout levels and when objective workload increases. These findings support the conceptualization of referrals rates as objectively measured negative outcomes of burnout. Further replications with other objective outcomes, additional HMOs and bigger samples are warranted.
Indexed as
Identifiers
What OpenQuestion holds
Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.