Background
Burnout is a syndrome of emotional exhaustion, depersonalization and low personal accomplishment that leads to decreased effectiveness at work. Physicians are especially vulnerable to develop burnout due to chronic stresses in the medical environment. There is no data on Israeli physicians that is based on Gold Standard measures of burnout. Additionally, so far the effects of physician burnout on objective measures of their behavior in the medical encounter have not been studied empirically. 

Objectives
1. To assess burnout prevalence in a sample of primary physicians (using a Gold Standard measure) and its associations with personal and job characteristics.
2. To assess the association between physicians' burnout levels and the rates of prescribing medications and referring patients to diagnostic tests and other providers of health services.

Methodology
136 primary physicians in community clinics in one area of one HMO responded to a structured questionnaire in an interview. The rates of prescriptions and the various referrals were obtained from the HMO's data bases.

Findings
56% of these physicians had high burnout levels. Burnout was not associated with any of the socio-demographic details. Burnout was predicted by subjective workload and job satisfaction. Only the rate of referrals to expensive imaging tests was predicted independently by emotional exhaustion, but the association was modest. Writing prescriptions was not related to burnout.

Conclusions
Among the physicians studied, burnout had almost no effect on the objective parameters examined and therefore it had no economic implications to the HMO.

Policy Implications / recommendations
Replicate the study in a larger and more homogenous sample. Follow up burnout levels among primary physicians, and devise organizational and personal-level interventions for reducing its prevalence, 1. Because of established associations between burnout and physical, emotional and occupational health, and patient satisfaction; and 2. to prevent physicians from searching for alternative professional and occupational alternatives, thereby increasing physician shortage.

Research number: A/109/2007

(1) Faculty of Health Sciences, Ben-Gurion University of the Negev
(2) Leumit Sick Fund