Sadly, physician burnout is becoming an increasing problem in American health care, with more than half of doctors reporting signs of burnout in a recent survey by Mayo Clinic and American Medical Association researchers.
The pressure can begin as early as medical school, and according to the survey has significantly worsened since 2011.
“Burnout manifests as emotional exhaustion, loss of meaning in work, and feelings of ineffectiveness,” said Tait Shanafelt, M.D., lead author of the study. “What we found is that more physicians in almost every specialty are feeling this way and that’s not good for them, their families, the medical profession, or patients.”
Physicians with burnout suffer from any combination of the following:
- anger and hostility;
- reduced job satisfaction and productivity;
- insufficient work/life balance;
- conflict at work and at home;
- tiredness and problems sleeping;
- negative impacts on physical and mental health.
In addition, statistics indicate that 250 to 400 doctors are lost to suicide each year in the United States. This represents a rate 1.4 to 2.3 times higher than in the general population. While physician deaths from smoking and heart disease are decreasing, suicide rates show no sign of decreasing.
A 2011 study of more than 2,000 doctors, conducted by Physician Wellness Services and Cejka Search, found that stress and burnout are extremely prevalent. Almost 87 percent of respondents identified themselves as “moderately to severely stressed and/or burned out on an average day.” Within this number were 38 percent who feel “severe stress and/or burnout.”
The authors state, “The study clearly showed that not only is it prevalent, but stress and/or burnout is increasing. Almost 63 percent of respondents said they were more stressed and/or burned out than three years ago. The largest number of respondents (34 percent) identified themselves as “much more stressed” than they were three years ago.
Stress levels at most medical schools can run high. Medical students face fierce competition for residency positions and are under pressure to perform at a very high level academically. They must also study at night, and may feel pressure to volunteer to stay late, come in early, and do as much extra work as possible.
In addition to the doctors themselves, their family members, staff, and patients can also feel the negative effects of this burnout. Patient safety may be affected.
For example, a burned-out doctor may have difficulty making decisions, communicating effectively; there may be an increased risk of medical errors. Conversely, personal factors can also contribute to burnout. The survey examined the primary causes of burnout, particularly in the three areas of “external factors,” “work-related factors” and “personal life factors.”
The top three external factors were found to be the state of the U.S. economy in general (cited by 52 percent of respondents), health care reform (46 percent), and policies of the federal Centers for Medicare and Medicaid Services (41 percent).
The main work-related factors that caused burnout were paperwork and administrative demands (40 percent), too many hours of work (33 percent), and on-call schedules and expectations (26 percent). Regarding personal life factors, the main problem areas were not enough time to relax or for leisure/recreational activities (53 percent), not enough time for exercise or wellness activities (51 percent), and concerns about work/life balance (45 percent).
In terms of prevention or recovery, each doctor will have unique issues to resolve and different solutions. The survey by Physician Wellness Services asked respondents what they were doing on their own to try to address burnout.
The most common methods were exercise and spending time with family and friends. Other approaches included taking time off, getting more sleep, getting coaching or mentoring, or doing yoga or meditation. However, a lack of time was widely cited as a barrier to relieving stress.
A fairly small proportion (16 percent) of respondents had organizations that were taking steps to relieve physician burnout. These often included wellness initiatives, workshops and education, onsite exercise facilities or classes, and Employee Assistance Programs, counseling, or other behavioral health services.
In the opinion of the respondents themselves, the most helpful changes would include more ancillary support or staff support to deal with administrative tasks. Overall, they wanted more time for the things that are most important to them at work and in their personal lives, more opportunities for exercise and other wellness activities, and more support to deal with stress and burnout in their lives. This final category often included needing greater respect and recognition for their efforts and contributions.
Dr. Pallavi Bradshaw, of the Medical Protection Society in London, U.K., said, “Doctors have to make difficult decisions daily, alongside rising patient expectations and fewer resources. These challenges are impacting on doctors’ emotional health, and yet so few are seeking support.”
It is important that doctors learn how to recognize early signs of burnout, and that medical schools and hospital systems support the cultural shift necessary to limit or resolve the burnout epidemic facing doctors today.
Physician Wellness Services and Cejka Search Physician Stress and Burnout Survey November, 2011.
Schernhammer, E. S. and Colditz, G. A. Suicide rates among physicians: a quantitative and gender assessment (meta-analysis). The American Journal of Psychiatry, December 2004, volume 161, issue 12, pp. 2295-2302.
Shanafelt, T., et al. Changes in Burnout and Satisfaction With Work-Life Balance in Physicians and the General US Working Population Between 2011 and 2014. Mayo Clinic Proceedings, December 2015, volume 90, issue 12, pp. 1600-1613.