During the past 20 years, the Research Unit for General Practice in Aarhus has been conducting surveys among general practitioners (GPs) to assess their job satisfaction and wellbeing. From 2012 to 2016, a large increase in burnout was seen. At the time, this increase was interpreted as a reaction to the tempestuous conflict between general practice and the Danish regions. However, the level of burnout has remained high since then.

Same trend seen abroad

In 2023, 34% of GPs met the criteria for moderate burnout, and 14% met the criteria for severe burnout. This is an increase of 21 per cent in moderate burnout since the previous survey in 2019 and an increase of 44 per cent in severe burnout.

The high prevalence of burnout among GPs is echoed in international studies and is seen in parallel with an increase in the number of consultations and other workload indicators.

Burnout is a sign of poor well-being

A new survey, which was conducted by the Danish Junior Doctors' Association (Yngre Læger) among junior doctors and family medicine specialist working in general practice, shows that future GPs are highly concerned about the work pressure and the risk of burnout.

Burnout is not a diagnosis, but a condition that was introduced in psychology in the 1970s based on interviews and field studies of healthcare professionals, school teachers and correctional officers.

Burnout is characterised by emotional exhaustion, depersonalisation and sense of low personal job accomplishment. However, the condition is reversible if the necessary actions are taken. Like many previous studies, the new survey shows that burnout is associated with sleep disturbances, low self-rated health, risky alcohol behaviour and desire for early retirement. Therefore, burnout is a marker of poor wellbeing that requires attention.

Major regional differences

When taking age and gender differences into account, Region Zealand has the highest number of GPs who fulfil the criteria for moderate burnout (52%), whereas Region Zealand and the North Denmark Region have the highest number of GPs who fulfil the criteria for severe burnout (16%).

The relatively higher prevalence of burnout in Region Zealand and the North Denmark Region could be due to a higher workload caused by a population with increased morbidity. Hence, the Danish Health Profile 2021 showed that citizens in Region Zealand and the North Denmark Region have the highest and second-highest prevalence of poor self-reported physical health, respectively.

Figures from the Danish Organization of General Practitioners (PLO) have shown that Region Zealand and the North Denmark Region comprise relatively many municipalities with high numbers of clinics that have closed their practice list to new patients. This usually reflects a shortage of GPs in the area, as the remaining GPs must then handle the highest possible number of patients. Thus, the variations in burnout across regions appear to be associated with variations in citizen morbidity and GP shortage.

Perceived quality of the work

In 2023, burnout was strongly associated with the experience of not being able to perform your job at a satisfactory level of quality. The correlation is hard to explain and can be seen as a chicken-or-egg causality dilemma. However, a previous study showed that GPs dealing with time pressure by compromising on quality and postponing tasks and decisions have a higher risk of burnout three years later. This suggests that a large gap between expectations and actual conditions may negatively affect wellbeing.

The number of services does not in itself appear to affect the risk of burnout. Rather, it seems that providing care for patients with complex needs may cause burnout. In 2023, 66% of GPs felt burdened by the volume of complex patient contacts (an increase of 53% since 2016). Registry data have documented that GPs with high numbers of patients with multimorbidity on their patient list have an increased risk of burnout.

Working hours and risk of burnout

In 2023, Danish GPs reported an average working week of 45 hours, and high number of weekly working hours was strongly associated with burnout. In view of the high number of  working hours, it is not surprising that around one in four of the GPs experienced work-life conflict.

Despite the high number of average working hours per week, 60 per cent of GPs indicated to have a 4-day working week. This could isuggest that some GPs try to cope with the high workload by reducing the number of working days in their clinic. This may in itself complicate the relation between the expectations to own performance and the demands of serving as a GP and running a clinic.

Factors affecting job satisfaction

While the figures show that almost half of the GPs met the criteria for moderate burnout in 2023, it should be noted that the other half (47 per cent) indicated to have the desired level of job satisfaction to a very high or high degree. A good working environment with GP colleagues in the clinic was the factor that was most frequently highlighted as important for job satisfaction. A British study has shown that the more GPs in a practice per 1,000 patients, the higher the job satisfaction and the fewer hours worked per week.

Autonomy to shape own working life was indicated by one in five GPs as an important factor for job satisfaction, which is 17% less than in 2019. A cautious interpretation of this finding could be that although most specialists in family medicine would prefer to have their own clinic, there is a group of GPs who are not motivated by owning, running and managing their own clinic, but they are still dedicated to the work in general practice.

A recent report from the Danish Center for Social Science Research (VIVE) shows that doctors who have chosen to be employed in general medical services constitute a small group, but this group is growing. The survey, which was conducted by the Danish Junior Doctors' Association, shows that 10 per cent of junior GPs do not want to own their practice. It is important to have attractive career paths for this group of specialist doctors to ensure that they do not choose occupations outside general practice.

Use of support staff

The organisation in general practice is developing towards partnerships and increased support from staff. In the recent wellbeing survey, we saw that midwives and bioanalysts are now employed in 10-15 per cent of the clinics in general practice in Denmark.

Several British studies have investigated how the activities in general practice are influenced by increased systematic use of support staff, and the results are ambiguous. For example, it does not appear to reduce the GPs' working hours. Besides, clinics that systematically use support staff often have a strong focus on the organisation of the work in general practice to avoid duplication of efforts.

One study found that reorganising the clinics according to Lean principles was associated with increased burnout. There seems to be a need to obtain more knowledge on the impact of standardised task performance, and whether this may cause lower sense of meaning for some individuals, as 'sense of meaning' is the key factor in preventing severe burnout.

Key points

• The past 20 years of monitoring have documented a sharp increase in burnout among GPs in Denmark. In the 2023 survey, it is clearly seen that regional variations in burnout coincide with regional differences in citizen morbidity and GP shortage.
• Having GP colleagues is important for job satisfaction. Collaboration with other staff in the clinic also contributes to job satisfaction, and support staff may help solve some of the existing capacity limitations in general practice.
• However, research has not been able to document that support staff may reduce GP working hours, which averaged 45 hours per week in 2023. Career paths must be ensured for specialists in family medicine who do not aim to own their practice, so that they will find it attractive to stay in the workforce in general practice.

Read all the reports (in Danish) under the focus area ”GP job satisfaction”.

This article was originally published in the Danish periodical Practicus no. 269 (pages 15-17), March 2024.