Physician Factors Associated With Burnout During System-Wide Electronic Health Record Implementation: A Prospective Repeated Cross-Sectional Study of Acute and Post-Acute Care Physicians.

rationalePhysician burnout is a major concern, particularly during periods of large-scale institutional change such as electronic health record (EHR) implementation. AIMS AND

objectivesTo examine associations of burnout with physician age, clinical experience, and after-hours documentation burden ('pyjama time') among acute and post-acute care physicians undergoing EHR implementation, and secondarily to evaluate changes in burnout across three phases of EHR implementation (Pre-Implementation, Post-Implementation, Post-Optimisation).

methodsWe conducted anonymous electronic surveys of acute and post-acute care attending physicians at a tertiary academic health system in Toronto, Canada across three phases of EHR implementation. Burnout was assessed using the Maslach Burnout Inventory Human Services Survey-Medical Personnel (MBI-HSS-MP). Univariable and multivariable logistic regression analyses identified factors associated with high emotional exhaustion, high depersonalisation, and low personal accomplishment.

resultsWe collected 306 responses in Pre-Implementation, 248 in Post-Implementation, and 214 in Post-Optimisation. Overall burnout levels remained stable across implementation phases (p ≥ 0.05). Physician age ≥ 65 years was independently protective across all burnout domains (adjusted odds ratio [aOR] 0.33-0.49; p < 0.01). Physicians with > 20 years in practice were less likely to report high depersonalisation (OR 0.39; p < 0.01) or low personal accomplishment (OR 0.54; p = 0.01). Increasing pyjama time was associated with higher odds of emotional exhaustion on univariable analysis (OR 1.06 per hour; p < 0.03) and remained independently associated with depersonalisation after adjustment (aOR 1.07; p = 0.02). Documentation burden peaked in the Post-Implementation phase (mean pyjama time 381.6 min/day), with higher depersonalisation observed on univariable analysis (OR 1.51; p < 0.02), although this association attenuated after adjustment.

conclusionIn this three-phase study, after-hours documentation burden was strongly associated with depersonalisation, while physician age ≥ 65 years consistently protected against burnout. Although overall burnout levels remained stable across implementation phases, the immediate Post-Implementation period was characterised by substantial documentation burden and transient increases in depersonalisation, highlighting the importance of robust training, workflow optimisation, and targeted support during early EHR adoption.