What Are the Causes of Burnout?
Ranking at the top of the causes of burnout in the Medscape survey were those that suggested an excessive workload and loss of control over the profession: "too many bureaucratic tasks" and "spending too many hours at work." On a scale of 1 to 7, where 1 = not at all important and 7 = extremely important, these stressors averaged over 4, as did "insufficient income" and "feeling like just a cog in the wheel." One survey respondent summarized these issues:
"Always new rules and regulations to keep up with, threats of audits and money being taken away if [there are] minor issues with documentation. Constant time [required] to fill out prior authorizations for medication (which are almost never denied because I always have a sound medical reason for what I do). It's really awful sometimes, and I wish I could just take care of my patients rather than the insurance and payments and unnecessary requirements for documentation just to get paid."
Every specialty saw "too many bureaucratic tasks" and "too many hours at work" among its top 3 stressors, but there was some variation across specialties for the other leading cause of burnout.
Intensivists and oncologists were the only specialists to list "compassion fatigue" in their top 3. Compassion fatigue is defined as "a traumatizing emotional state experienced...by caregivers who are preoccupied with the suffering and distress of those they are caring for." One report found greater emotional exhaustion in oncology healthcare professionals than in healthcare professionals caring for patients with HIV or AIDS. (This was supported by the Medscape survey, in which HIV/ID specialists listed compassion fatigue as last on the list, perhaps because many HIV patients are surviving their disease.)
The "present and future impact of Affordable Care Act" fell within the top 3 burnout causes for some -- but not most -- specialties. Those most affected by this stressor were specialists who performed procedures and whose incomes are threatened by ACA reforms: anesthesiologists, orthopedists, dermatologists, gastroenterologists, radiologists, cardiologists, and general surgeons. Seth Bilazarian, an interventional cardiologist, observed about the impact of the ACA, "On the one hand, they are saying that it is wonderful that patients are being covered, but on the other hand, what will this do to societal costs, delivery of medicine, American innovation in medicine, and a variety of other things? All of these things are contributing to physician burnout." Not surprising is that those least concerned with the effects of the ACA tended to be the generalists, who might benefit from its provisions: family physicians, internists, pediatricians, psychiatrists, and intensivists.
Family physicians and internists were the only specialists to name "feeling like just a cog in the wheel" to their top 3 stressors, and pediatricians, ob/gyns, and neurologists were the only ones to include "income not high enough" among their top 3.
"Inability to provide patients with the quality care that they need" was ranked among the top 3 stressors by psychiatrists only, and "too many difficult patients" was a leading concern only for emergency medicine physicians.
It is clear, however, that for all specialists, institutional pressures play the primary role in their burnout.