Physician Burnout

Burnout: a By-product of Primary Care Practice

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Feeling frustrated and burnt out by your practice, your patients, and your life in general?  You’re not alone. In a newly published survey of almost 7300 physicians throughout the U.S, 46% reported at least one symptom of burnout. 

When applied to healthcare professionals, burnout is a psychological term involving emotional exhaustion, depersonalization, and a diminished sense of personal accomplishment.[1] Burnout is caused by excessive and prolonged stress, leaving you overwhelmed and unable to meet the constant demands of work, home, and life in general. Although difficult to fully measure and quantify, there is a growing body of information suggesting that clinician burnout is associated with an increased risk of medical errors, early retirement, increased rates of alcoholism and suicide. Burnout may negatively influence the quality of care provided to patients, as well.[2]

To better determine whether physicians are more prone to burnout than other working professionals, a team of researchers from the Mayo Clinic conducted a national study that included physicians from all specialties and compared them to almost 3500 U.S. nonphysician adults.[3] The study was published online in the Archives of Internal Medicine on August 20, 2012.

Among the 27,276 physicians invited to participate in the survey, 7,288 responded (27%).  The respondents were 71% male with a median age of 55. Among the comparison group, 69% were employed, 8.4% had been temporarily laid off, 8.2% were disabled and 13.6% were retired or were not working for another reason. Compared with the physicians, the control group was younger, more likely to be female and less likely to be married.

Overall, 46% of physicians reported at least one symptom of burnout based on the Maslach Burnout Inventory. Respondents indicated that 38% of them were emotionally exhausted, 29.4% had high depersonalization and 12.4 % reported a low sense of personal accomplishment. Compared with 3,442 working U.S. adults, physicians were significantly more likely to have symptoms of burnout (37.9% versus 27.8%) and to report dissatisfaction with their work-life balance (40.2% versus 3.2%).  Physicians worked a median of 10 hours more per week than the controls (50 versus 40 hours), with 38% of physicians and 11% of population controls working 60 hours or more per week.

Of note is that differences in burnout varied by specialty with emergency medicine, general internal medicine, neurology and family medicine reported the highest burnout rates; pathology, dermatology, general pediatrics and preventive medicine had the lowest rates.

A second report in the same journal took a ‘behind the scenes look’ at the various work tasks required of 82 general internists at the Mayo Clinic.[4] The authors report that on a typical clinical day, an internist typically ordered 70 laboratory tests, images, and consultations; wrote and signed 31 prescriptions; responded to 7 patient care–oriented messages; and reviewed, edited, and signed 19 documents within the electronic medical record. The authors note that most of these tasks occur outside the actual patient visit and take up a substantial proportion of the work day—before a single patient is seen.

The data from both studies corroborate findings from The Physicians’ Foundation, which surveyed more than 12,000 primary care physicians in 2008 and found that among the respondents:[5]

  • 78% felt medicine was “no longer rewarding” or is “less rewarding”
  • 49% said they would retire if they could afford it
  • 30% to 50% said they would not attend medical school if starting again
  • Only 28% would become primary care physicians if starting again, opting instead for surgical  or diagnostic specialties
  • Over 60% of physicians reported spending at least 11 hours per week on non-clinical “paperwork” duties.

Sadly, 60% of the physicians also said they would not recommend medicine as a career path for young people.

The authors of this new study are troubled by the fact that almost 1 in 2 physicians suffers symptoms of burnout, and suggested that both policy makers and healthcare organizations must do more to address the problems of physician burnout. They also call for the development of interventions that will allow clinicians to provide the best possible care of their patients while reducing the paperwork and administrative burden.

So what’s a weary clinician to do?

Part of the solution is to think about new ways to care for patients; the other part is to think about new ways to care for yourself. We provided some in-depth ideas to help you deal with the problem of burnout back in early 2011 and two of them deserve repeating here.

Take control of your practice 

  • Adjust your schedule to accommodate your strongest and weakest times of day
  • Maximize the use of clinician extenders
  • Cross-train your office staff in triage and ask for their ideas about improving office flow
  • Train your staff to minimize interruptions while you’re seeing patients
  • Focus on one patient at a time
  • Challenge patients to take more responsibility for self-care
  • Consider using email or the telephone to manage patients’ questions

Take control of your life

  • Drink plenty of water and juice; limit caffeine, alcohol and tobacco
  • Spend time with family and friends
  • Sustain your recreational activities
  • Develop friendships outside of the healthcare community
  • Nourish your spiritual needs
  • Seek out help when you begin to feel overwhelmed, angry, frightened or negative
  • Get regular checkups from a healthcare provider you like and trust. While this sounds intuitive, some data suggest that up to a third of physicians do not have a regular source of healthcare.[6]

To get a better handle on your burnout level, try this on-line self-assessment. Then, navigate to this article from the New England of Journal of Medicine to read more about innovative interventions that might help allay your feelings of stress and anxiety before they lead to burnout.

 

Jill Shuman, MS, ELS
Published on September 11, 2012

 

References

  1. Poghosyan L, Aiken L, Sloane D.  Factor structure of the Maslach Burnout Inventory: an analysis of data from large scale cross-sectional surveys of nurses from eight countries.  Int J Nurs Stud. 2009;46(7):894-902.
  2. Wallace JE, Lemaire JB, Ghali WA. Physician wellness: a missing quality indicator.  Lancet. 2009;374(9702):1714-1721.
  3. Shanafelt TD, Boone S, Litjen T, et al.  Burnout and satisfaction with work-life balance among US physicians relative to the general US population. Arch Int Med. 2012; doi:10.1001/archinternmed.2012.3199 4.  Dyrbye LN, West CP, Burriss TC, Shanafelt TD.  Providing primary care in the United States: the work no one sees.  Arch Int Med. 2012; Aug 20 [online before print].
  4. Physician Foundation.  The Physicians’ Perspective: Medical Practice in 2008.  http://www.physiciansfoundation.org/healthcare-research/the-physicians-perspective-medical-practice-2008. Accessed February 2015.
  5. Gross CP, Mead LA, Ford DE, Klag MJ. Physician, heal thyself? Regular source of care and use of preventive health services among physicians. Arch Intern Med. 2000;160(21):3209-3214.