Abstract
PURPOSE: To analyse the course of burnout and develop an explanatory model. DESIGN: Prospective cohort dynamics. SITE: All primary health care centres in Burgos. SUBJECTS: All physicians except medical emergencies, paediatrics and residents. MAIN MEASUREMENTS: Anonymous self-report questionnaire: Maslach Burnout Inventory (MBI) and related variables. An analysis was performed using the Student-t, X(2) test and logistic regression. RESULTS: The response rate was 47.76% in 2007, which was lower than that of 2005. There were significant differences between 2005 and 2007, for increases in the percentage of physicians who smoked, postgraduate training, residency, and those who believe that coordination with nursing and specialist care and institutional communication is appropriate. There was an increase in the prevalence of burnout by almost one point compared with 2005, a decrease in maximum burnout and emotional exhaustion (EC), and an increase in depersonalisation (DP) and personal accomplishment (RP). The incidence density of burnout was 1/113. 5 primary care physicians per year. The existence of burnout is associated with the use of chronic medication and inadequate coordination between nursing and EC, and also with the high workload. CONCLUSIONS: The increase in the prevalence found is consistent with the idea of burnout as a dynamic development and the theoretical model described. Stable and quality employment is one way to indirectly mitigate (by encouraging internal communication) professional burnout. In the multivariate analysis, the most critical variable in the onset of burnout is the inadequate coordination with nursing.