Keywords: General Practitioners, Workload, Morbidity

Introduction:

Complexity in primary care is often measured using morbidity stratifiers (such as Adjusted Morbidity Groups, AMGs). However, the ‘perceived complexity’ by the physician is often related to a lack of time to meet demand. This study evaluates these variables, variables related to the burden of care, and professional burnout.

Method:

A descriptive, cross-sectional, multicenter, and serial study using convenience sampling. Participants: family physicians from primary care centers in Catalonia (Spain). Workloads were compared using clinical activity records—collected prospectively and in real-time to avoid recall bias—for a full week in May 2025. Variables: Visit volume, resolution, adequacy, clinical relevance, burnout (MBI), perceived complexity (defined as lack of time to address patient demand within the assigned slot), and biological complexity measured with Adjusted Morbidity Groups (AMG). Burnout is defined as the simultaneous impairment of the three MBI dimensions. Statistical analysis: Student's t-test for mean comparisons, Chi-square for categorical variables, and Logistic Regression to calculate Odds Ratios (OR) for burnout predictors (p<0.05).

Results:

57 family physicians. Average biological complexity (AGM) of patients: 2.45. Biological Complexity (AGM) and Burnout: physicians with Burnout (2.49) and the rest of the cohort (2.44) (p=0.171). In the logistic regression model, first the primary predictor of Burnout was the perception of insufficient time in >30% of visits (OR=11.6; p=0.010), second the psychosocial visits obtained an odds ratio (OR) of 4.2 (p = 0.028). Global resolution rate (44.5%) showed no significant correlation with increased mean AGM (p>0.05). In patients with higher biological complexity (AGM > 3), perceived clinical relevance increased significantly (p<0.001), despite an increase in accumulated delay (p=0.023).

Conclusions:

Biological complexity (AGM) does not predict severe burnout; exhausted professionals do not treat patients with higher disease burdens. Instead, perceived complexity—insufficient time—is the decisive factor.