Physician Factors Associated With Burnout During System‐Wide Electronic Health Record Implementation: A Prospective Repeated Cross‐Sectional Study of Acute and Post‐Acute Care Physicians

Abstract

ABSTRACT Rationale Physician burnout is a major concern, particularly during periods of large‐scale institutional change such as electronic health record (EHR) implementation. Aims and Objectives To examine associations of burnout with physician age, clinical experience, and after‐hours documentation burden (‘pyjama time’) among acute and post‐acute care physicians undergoing EHR implementation, and secondarily to evaluate changes in burnout across three phases of EHR implementation (Pre‐Implementation, Post‐Implementation, Post‐Optimisation). Methods We conducted anonymous electronic surveys of acute and post‐acute care attending physicians at a tertiary academic health system in Toronto, Canada across three phases of EHR implementation. Burnout was assessed using the Maslach Burnout Inventory Human Services Survey–Medical Personnel (MBI‐HSS‐MP). Univariable and multivariable logistic regression analyses identified factors associated with high emotional exhaustion, high depersonalisation, and low personal accomplishment. Results We collected 306 responses in Pre‐Implementation, 248 in Post‐Implementation, and 214 in Post‐Optimisation. Overall burnout levels remained stable across implementation phases (p ≥ 0.05). Physician age ≥ 65 years was independently protective across all burnout domains (adjusted odds ratio [aOR] 0.33‐0.49; p < 0.01). Physicians with > 20 years in practice were less likely to report high depersonalisation (OR 0.39; p < 0.01) or low personal accomplishment (OR 0.54; p = 0.01). Increasing pyjama time was associated with higher odds of emotional exhaustion on univariable analysis (OR 1.06 per hour; p < 0.03) and remained independently associated with depersonalisation after adjustment (aOR 1.07; p = 0.02). Documentation burden peaked in the Post‐Implementation phase (mean pyjama time 381.6 min/day), with higher depersonalisation observed on univariable analysis (OR 1.51; p < 0.02), although this association attenuated after adjustment. Conclusion In this three‐phase study, after‐hours documentation burden was strongly associated with depersonalisation, while physician age ≥ 65 years consistently protected against burnout. Although overall burnout levels remained stable across implementation phases, the immediate Post‐Implementation period was characterised by substantial documentation burden and transient increases in depersonalisation, highlighting the importance of robust training, workflow optimisation, and targeted support during early EHR adoption.