The Virginia Joy in Healthcare pilot is an initiative of the Virginia Task Force on Primary Care, staffed by the Virginia Center for Health Innovation, with funding support from the Commonwealth of Virginia. This report was developed by VCHI on behalf of the Task Force.

This webpage includes the Appendices from the published report APP Burnout in Primary Care.

Click Here to View the 2026 Virginia Joy in Healthcare Findings Full Report

A note on the data:

In the data summaries that follow, the phrase ‘Virginia results’ refers to the pooled results from the five Virginia organizations surveyed in 2025. The phrase ‘national results’ refers to results collected from across the states as reported by AMA. The national results are referenced in selected sections and included in multiple appendix tables as context for considering the Virginia findings.

Throughout appendices, percentages may not total to precisely 100% due to rounding.

Certain data are unavailable at the national level. All available national comparisons are provided.

Appendices

Appendix A. Burnout Symptoms

Surveyed clinicians were asked the question:

“Using your own definition of “burnout”, please choose one of the answers below:

  1. I enjoy my work. I have no symptoms of burnout.
  2. I am under stress, and don’t always have as much energy, but I don’t feel burned out.
  3. I am beginning to burn out and have one or more symptoms of burnout, e.g., emotional exhaustion.
  4. The symptoms of burnout that I’m experiencing won’t go away. I think about work frustrations a lot.
  5. I feel completely burned out. I am at the point where I may need to seek help.”

Responses are combined where responses 1 and 2 indicate clinicians reporting no burnout indicators, and responses 3, 4, and 5 indicate reports of burnout.

Appendix B. Intention to Reduce Clinical Hours

Surveyed clinicians were asked the question:

“What is the likelihood that you will reduce the number of hours you devote to clinical care over the next 12 months?

  1. Definitely
  2. Likely
  3. Moderately
  4. Slight
  5. None”

Responses are combined where responses 1, 2, and 3 indicate a reported likelihood to reduce clinical hours, and responses 4 and 5 indicate no reported likelihood to reduce clinical hours.

Appendix C. Systemic Drivers Responses

Surveyed clinicians who reported intent to reduce clinical hours were asked to check all of the answers that apply, given the question:

“What would keep you in your role with at least the current amount of clinical %FTE?”

Appendix D. After-Hours EHR and Documentation Responses

Question 1 refers to the hours per week spent in the EHR outside of scheduled patient contact.

Surveyed clinicians were asked the question:

“How much time in a week do you spend on the electronic medical/health records (EMR/EHR) outside of your scheduled patient contact hours?

  1. 0-2.0 hours
  2. 1-4.0 hours
  3. 1-6.0 hours
  4. 1-8.0 hours
  5. More than 8 hours”

Question 2 refers to the characterization of time spent in the EHR outside of scheduled work hours.

Surveyed clinicians were asked the question:

“The amount of time I spend on the electronic health record (EHR) outside normal/scheduled work hours, including work done at home is…

  1. Minimal/none
  2. Modest
  3. Satisfactory
  4. Moderately high
  5. Excessive”

Responses are combined where responses 1, 2, and 3 indicate a reported satisfaction with EHR time outside of regularly scheduled hours, and responses 4 and 5 indicate dissatisfaction.

Question 3 refers to EHR limitations on effectively delegating tasks to support staff.

Surveyed clinicians were asked the question:

“What prevents you from delegating more order entry, medication review, visit note documentation, forms completion, or processing prescription renewals to support staff?”

With the provided response:

“My EHR is not built to support this kind of delegation.”

With the option to:

  1. Agree strongly
  2. Agree
  3. Neither agree nor disagree
  4. Disagree
  5. Disagree strongly

Responses are combined where:

  • Responses 1 and 2 indicate agreement with the statement “My EHR is not built to support this kind of delegation”, or EHR limitations on delegation.
  • Response 3 is categorized as neutral regarding EHR build as a roadblock for delegation.
  • Responses 4 and 5 indicate disagreement, or no EHR limitations on delegation.

Appendix E. Support Staff and Delegation Responses

Question 1 refers to inadequate access to Medical Assistants (MAs) or nurses.

Surveyed clinicians were asked the question:

“What prevents you from delegating more order entry, medication review, visit note documentation, forms completion, or processing prescription renewals to support staff?”

With the provided response:

“I do not have enough MAs or nurses.”

With the option to:

  1. Agree strongly
  2. Agree
  3. Neither agree nor disagree
  4. Disagree
  5. Disagree strongly

Responses are combined where:

  • Responses 1 and 2 indicate agreement with the statement “I do not have enough MAs or nurses, which prevents me from delegation”, or not enough MAs or nurses to delegate.
  • Response 3 is categorized as neutral regarding adequate access to MAs or nurses as a barrier to delegation.
  • Responses 4 and 5 indicate disagreement, or enough MAs or nurses to delegate.

Question 2 refers to concerns of reliability or training of MAs or nurses.

Surveyed clinicians were asked the question:

“What prevents you from delegating more order entry, medication review, visit note documentation, forms completion, or processing prescription renewals to support staff?”

With the provided response:

“I do not trust my MA or nurse to reliably do the work well

With the option to:

  1. Agree strongly
  2. Agree
  3. Neither agree nor disagree
  4. Disagree
  5. Disagree strongly

Responses are combined where:

  • Responses 1 and 2 indicate agreement with the statement “I do not trust my MA or nurse to reliably do the work well, which prevents me from delegating”, or a distrust in the reliability of MAs or nurses.
  • Response 3 is categorized as neutral regarding concerns of reliability or training for MAs or nurses as a barrier to delegation.
  • Responses 4 and 5 indicate disagreement or trust in the reliability of MAs or nurses.

Appendix F. Values-Alignment with Organizational Leadership Responses

Surveyed clinicians were provided the statement:

“My professional values are well aligned with those of my clinical leaders.

With the option to:

  1. Agree strongly
  2. Agree
  3. Neither agree nor disagree
  4. Disagree
  5. Strongly disagree

Responses are combined where responses 1 and 2 indicate agreement with the statement, or values alignment, response 3 is categorized as neutral, and responses 4 and 5 indicate disagreement, or misaligned values.

Appendix G. Feelings of Control Over Workload Responses

Surveyed clinicians were provided the statement:

“My control over my workload is…

  1. Optimal
  2. Good
  3. Satisfactory
  4. Marginal
  5. Poor

Responses are combined where responses 1, 2, and 3 indicate feelings of control over workload, i.e., autonomy, and responses 4 and 5 indicate a perceived lack of control over workload.