Over the past several decades, physicians have witnessed a gradual decline in their control over their work environments, a shift driven by multiple factors. Regardless of the causes, the consequences are clear: autonomy and flexibility have become increasingly scarce for medical professionals. A study published in the Annals of Internal Medicine highlights a direct connection between this loss of control and heightened levels of physician burnout, as well as an increased likelihood of doctors reducing their hours or leaving their jobs altogether.
“With these shifts, physicians often feel treated as a unit of productivity to be manipulated and afforded little control over their work environment,” stated the study, which was co-authored by Christine Sinsky, MD, vice president of professional satisfaction at the American Medical Association (AMA).
The study, based on a survey conducted in 2022 and 2023 with over 2,100 physicians, identified a link between burnout and inadequate control over patient load, team composition, workload, clinical schedule, and other responsibilities. Physicians who reported lacking sufficient control in these areas were significantly more likely to express intentions to cut back their working hours.
Among the surveyed physicians, 61.4% believed they had adequate control over their patient loads, while 60.6% felt they had sufficient authority over the composition of their clinical teams. Similarly, 61.3% said they had enough control over their workloads. However, only 49% reported having control over hiring staff, and 74.6% said they had enough say over their clinical schedules. When it came to accountability, 58.3% stated they had sufficient autonomy in the matters for which they were held responsible.
While the study did not establish a direct cause-and-effect relationship, the findings strongly suggested a correlation between these factors.
The authors of the study emphasized that for most physicians, job satisfaction is not solely about financial compensation. Physicians seek more than just monetary incentives to remain engaged and fulfilled in their profession. Although demanding and stressful, the job can be deeply rewarding when the right conditions are met.
“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 noted.
As a leader in physician well-being, the AMA is actively working to combat burnout by reducing administrative burdens and offering practical solutions aimed at helping physicians rediscover their passion for medicine.
Lack of Autonomy: A Major Contributor to Burnout
Although physician burnout has decreased from its record high in 2021, when the COVID-19 public health crisis pushed the healthcare workforce to its limits, it remains a significant problem in the United States. From physicians choosing to leave their jobs or cut their hours to the impact on patient care and satisfaction, burnout affects nearly every aspect of the healthcare system.
The study’s authors argued that health systems and physician practices could mitigate burnout—and its detrimental consequences—by granting doctors more control over their jobs and daily workflows, particularly in areas where they are ultimately held accountable.
“Providing control over these aspects of practice may seem at odds with organizational initiatives to standardize practice operations, including scheduling and workflows,” the study stated. “It is imperative, however, that organizations find the right balance between standardization and customization/flexibility.”
The Financial Toll of Burnout and High Turnover
The reduction of physician autonomy is driven by various factors, including the shift from physician-owned practices to employer-based models, the adoption of an industrial approach that prioritizes standardization over customization, and cultural changes that treat physicians more as commodities rather than professionals with individual expertise and decision-making abilities.
The study pointed out that physician burnout and the resulting workforce turnover impose significant financial burdens on healthcare organizations. The cost of replacing a departing physician can range from $500,000 to over $1 million in lost revenue, depending on factors such as specialty, location, and institutional investment in hiring and training. The AMA offers a calculator to help healthcare organizations assess the financial impact of physician attrition.
While some hospital executives may assume that increasing physician control over their work would be too expensive, the study’s authors suggested that failing to address the issue is actually far costlier.
Providing physicians with greater influence and decision-making power “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,” the study explained. “These findings may be critical to organizational and societal efforts to maintain an adequate physician workforce.”
However, improving physician autonomy alone is not enough to curb burnout. The study emphasized that additional measures must be implemented to address this widespread issue effectively.
“Ensuring adequate control over the clinical work environment should be considered one component of a holistic strategy to reduce burnout and retain physicians,” the authors wrote. “Reductions in burnout and turnover, in turn, have the potential to ensure adequate access to care and foster continuity and quality.”
The AMA provides open-access toolkits through its STEPS Forward® initiative, offering physicians and healthcare organizations innovative strategies to combat burnout, enhance efficiency, and create an environment that fosters job satisfaction and professional fulfillment.
By addressing the root causes of physician burnout—particularly the erosion of autonomy—healthcare organizations can not only improve job satisfaction but also enhance patient care, reduce costs, and secure a more stable medical workforce for the future.