Degree Date

2023

Degree

Doctor of Philosophy (PhD)

Department

Social Work and Social Research

Abstract

The delivery of behavioral health care in primary care shapes the patient-physician relationship, which is a core area of focus for examining patient outcomes. Though early research demonstrates the benefit of integrating physical and behavioral healthcare to the patient experience and health outcomes, little research examines the relational implications of this care from the perspective of the primary care physician, including the role of physician burnout. The following study utilized a mixed methods approach to first examine the experience of burnout among primary care physicians who work with patients with behavioral health needs and then, to explore the dynamics of their relationships with these patients. Qualitative findings from semi-structured interviews along with scores on the Maslach Burnout Inventory Human Services Survey for Medical Personnel (MBI-HSS MP) were analyzed from 15 physicians working in primary care for a large hospital network. Burnout scores were used to categorize participants into one of five burnout profiles, including engaged, overextended, ineffective, disengaged and burnout. Pen portraits were created for each participant and categorized by burnout profile. Findings revealed variation in physician relationship building and behavioral health treatment capacities along the burnout continuum, with burned-out physicians reporting more constraints on their time, scope of practice, and ability to maintain work-life balance, aspects that threated their relational philosophy of care with these patients. Implications for the role of medical social workers in supporting primary care patient-physician relationships with behavioral health patients is discussed.

Keywords: behavioral health, primary care, burnout, social work, integrated care, patient-physician relationship

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