Relationships of Educational Debt With Hours Worked and Burnout Symptoms Among Early-Career Family Physicians

PURPOSE Educational debt among physicians is growing and contributes to burnout symptoms. Work hours have been associated with burnout symptoms among medical learners and early-career physicians. It is not known if medical debt is directly associated with increasing work hours among early-career family physicians. METHODS We created a longitudinal cohort of family physicians who were 3 years into their career using data from the American Board of Family Medicine. We assessed whether educational debt at the time of residency graduation was correlated with hours worked and with burnout symptoms at this career stage. Logistic regression analysis was used to determine if educational debt level and hours worked per week were independently associated with burnout symptoms. RESULTS Among 4,905 early-career family physicians,17.8% had no educational debt while 16.2% had more than $350,000 of debt. Educational debt was positively correlated with mean hours worked per week (P =.002) and with burnout symptoms (P <.001). Also, mean hours worked per week were positively correlated with burnout symptoms (P <.001). In adjusted logistic regression analysis, family physicians had elevated odds of burnout if they had educational debt of $250,000 to $350,000 (adjusted odds ratio = 1.24; 95% CI, 1.01-1.51) and greater than $350,000 (adjusted odds ratio = 1.47; 95% CI, 1.19-1.82) as compared with no debt. Their odds of burnout symptoms also increased with work hours (adjusted odds ratio = 2.87; CI, 2.40-3.44 for ≥60 hours vs <40 hours weekly). CONCLUSIONS Among early-career family physicians, those with higher educational debt worked more hours. Both educational debt and work hours were independently associated with symptoms of burnout. Reducing educational debt may help prevent burnout symptoms and their downstream consequences.