Primary care panel load tied to clinician burnout

Clinical takeaway: Treat a panel formula as a ceiling, not a target to exceed; VA clinicians on overfilled panels reported more burnout and more intent to leave the system. 

For a health system short on primary care, empty panel slots look like free capacity. Assign more patients per clinician and access increases without hiring anyone. The arithmetic works only if clinicians absorb the added load at no cost to themselves or their patients. Primary care has the least room to make that bet, with burnout among its physicians staying high even as rates ease in the wake of the pandemic. 

Burnout among the primary care physicians at the Veterans Health Administration climbed to 58% by 2022, up from 46% four years earlier, resisting the mitigation efforts that eased it elsewhere in medicine. That same year, Congress passed one of the largest expansions of VA health care eligibility on record, and the system prepared for the influx in part by raising panel fullness targets, to as much as 105% of calculated panel size. A cross-sectional analysis of national VA survey data now maps what accompanied fuller panels and locates where the strain concentrates, a placement that lands close to the formula's own limit. 

Across three survey years, 55.2% of VA primary care practitioners reported burnout and 31.9% reported intending to leave the system, while panel fullness climbed to 92.8%, up from 86.3%. Each 10-percentage-point increase in fullness carried 7% higher odds of burnout and 9% higher odds of intention to leave, along with 10% lower odds of rating the workload reasonable. A facility's prior-year fullness was associated with 19% higher odds of intention to leave the following year. 

The final year cut against the trend: 2024 respondents reported less burnout, less intention to leave, and higher job satisfaction than 2023's, even as panels kept filling. The authors offer three explanations: fullness targets were walked back before the end of 2024, actual increases were modest, and burnout rates sustained above 50% may sit at a ceiling where added strain converts to intention to leave rather than more burnout. 

Plotted year by year, burnout and intention to leave turned upward once fullness passed roughly 90% of calculated size. Workload ratings fell furthest on panels running at 105% or more. More support staff per clinician actually tracked with more burnout, not less. The authors note that in the VA's model, added staffing triggers panel growth. Clinicians spending more of their visit time in person, rather than on telephone, video, or secure messaging, reported burnout at about half the rate. 

The analysis drew on 15,856 responses from physicians, nurse practitioners, and physician assistants on VA primary care teams to the system's annual All Employee Survey, 2022 through 2024, with response rates near or above 70% each year. Panel fullness and staffing came from VA administrative data, aggregated across 139 medical centers. Because survey responses could not be linked to individual panels, associations run at the facility level. 

VA panels average about 1,200 patients per physician, smaller than most systems, but the veteran population is older and carries heavier burdens of chronic disease, mental illness, and substance use, which is what a calculated panel size exists to absorb. A system comparing raw panel counts will misread slack that isn't there. Turnover comes at an estimated cost of $500,000 to $1 million per departing physician. 

Source: Mohr DC, et al. (2026 Sep 15) JAMA Netw Open. Panel Fullness, Burnout, and Intention to Leave Among Veterans Health Administration Primary Care Practitioners