Bias and Burnout: Evil Twins

Carol Peckham

| Disclosures | January 12, 2016


This year's Medscape Lifestyle Report covers two important aspects of a physician's personal life that could affect care of patients: burnout and bias. Over 15,800 physicians from over 25 specialties responded, providing some surprising responses relating to these issues. The survey also asked physicians about marijuana use and prescribing; political and religious leanings; and whether they were healthy, wealthy, and happy.

Physician Burnout: Rising or Falling?

This year's Medscape survey, echoing other recent national surveys,[1,2] strongly suggests that burnout among US physicians has reached a critical level. Burnout is generally defined as loss of enthusiasm for work, depersonalization, and a low sense of personal accomplishment. Burnout now even has its own code (Z73.0) in the 10th edition of the International Classification of Diseases (ICD-10), which defines it as a "state of vital exhaustion."[3] Some experts have suggested that burnout might be an illness in its own right, but research suggests that it is probably a form of depression, rather than a distinct disorder.[4,5]

Percentage of Physicians Reporting Burnout

A survey published this year in the Mayo Clinic Proceedings[1] on all physicians compared burnout between 2011 and 2014 and observed an increase in the percentage of physicians reporting at least one burnout symptom, from 45.5% to 54.4%. This year's Medscape lifestyle survey supported these findings, reporting higher burnout rates for the great majority of specialties this year even compared with last (Figure 1).

The highest percentages of burnout occurred in critical care, urology, and emergency medicine, all at 55%. In last year's report, critical care and emergency medicine were in the top two spots, with only slightly lower burnout percentages (53% and 52%, respectively), and urologists were in 10th place, at 47%. Higher burnout rates among emergency medicine physicians[6,7] and intensivists[8,9] have been noted in the literature as well. The effect of this higher rate on these professions compared with others is unclear. In one of the studies, the projected attrition rate among emergency medicine physicians was no greater than in other specialties.[7] Emergency medicine physicians, however, are toward the bottom in burnout severity scores in this year's Medscape report (see below); in contrast, intensivists reported the highest severity rating, which might have a larger long-term effect on these specialists.

This year, family medicine and internal medicine, in fourth and fifth places, followed the top three closely, with 54% reporting burnout. In 2015, these primary care physicians were third and fourth, at 50%—still within the top five, but with a lower burnout percentage than this year.

Figure 1. Physician Burnout: 2015 vs 2016

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  1. Shanafelt TD, Hasan O, Dyrbye LN, et al. Changes in burnout and satisfaction with work-life balance in physicians and the general US working population between 2011 and 2014. Mayo Clin Proc. 2015;90:1600-1613.

  2. Shanafelt TD, Boone S, Tan L, et al. Burnout and satisfaction with work-life balance among US physicians relative to the general US population. Arch Intern Med. 2012;172:1377-1385. Accessed December 5, 2015.

  3. World Health Organization. The ICD-10 Classification of Mental and Behavioural Disorders: Clinical Descriptions and Diagnostic Guidelines. Geneva: World Health Organization; 1992.

  4. Bianchi R, Schonfeld IS, Laurent E. Burnout-depression overlap: a review. Clin Psychol Rev. 2015;36:28-41. Abstract

  5. Bianchi R, Schonfeld IS, Laurent E. Is it time to consider the "burnout syndrome" a distinct illness? Front Public Health. 2015;3:158.

  6. Estryn-Behar M, Doppia MA, Guetarni K, et al. Emergency physicians accumulate more stress factors than other physicians—results from the French SESMAT study. Emerg Med J. 2011;28:397-410. Abstract

  7. Goldberg R, Boss RW, Chan L, et al. Burnout and its correlates in emergency physicians: four years' experience with a wellness booth. Acad Emerg Med. 1996;3:1156-1164. Abstract

  8. Embriaco N, Papazian L, Kentish-Barnes N, Pochard F, Azoulay E, Burnout syndrome among critical care healthcare workers. Curr Opin Crit Care. 2007;13:482-488. Abstract

  9. Papazian L, Kentish-Barnes N, Pochard F, Azoulay E. High level of burnout in intensivists: prevalence and associated factors. Am J Respir Crit Care Med. 2007;175:686-692. Abstract

  10. Babbott S, Manwell LB, Brown R, et al. Electronic medical records and physician stress in primary care: results from the MEMO Study. J Am Med Inform Assoc. 2014;21:e100-e106. Abstract

  11. Rabatin J, Williams E, Baier Manwell L, Schwartz MD, Brown RL, Linzer M. Predictors and outcomes of burnout in primary care physicians. J Prim Care Community Health. 2016;7:41-43.

  12. Houkes I, Winants Y, Twellaar M, Verdonk P. Development of burnout over time and the causal order of the three dimensions of burnout among male and female GPs. A three-wave panel study. BMC Public Health. 2011;11:240. Accessed January 3, 2016.

  13. Montgomery A. The inevitability of physician burnout: implications for interventions. Burnout Research. 2014;1:50-56. Accessed January 3, 2016.

  14. Enginyurt O, Cankaya S, Aksay K, et al. Relationship between organisational commitment and burnout syndrome: a canonical correlation approach. Aust Health Rev. 2015 Aug 10. [Epub ahead of print]

  15. Nelson KM, Helfrich C, Sun H, et al. Implementation of the patient-centered medical home in the veterans health administration: associations with patient satisfaction, quality of care, staff burnout, and hospital and emergency department use. JAMA Intern Med. 2014;174:1350-1358. Accessed December 27, 2015.

  16. Chapman EN, Kaatz A, Carnes M. Physicians and implicit bias: how doctors may unwittingly perpetuate health care disparities. J Gen Intern Med. 2013;28:1504-1510. Accessed January 4, 2016.

  17. Devine PG. Stereotypes and prejudice: their automatic and controlled components. J Pers Soc Psychol. 1989;56:5-18.

  18. Simon JR, Dwyer J, Goldfrank LR. The difficult patient. Emerg Med Clin North Am. 1999;17:353-370. Abstract

  19. Adams J, Murray R 3rd. The general approach to the difficult patient. Emerg Med Clin North Am. 1998;16:689-700. Abstract

  20. Edgoose J. Rethinking the difficult patient encounter. Fam Pract Manag. 2012;4:17-20. Accessed January 3, 2016.

  21. O'Dowd TC. Five years of heartsink patients in general practice. BMJ. 1988;297:528-530. Abstract

  22. Gudzune KA, Beach MC, Roter DL, Cooper LA. Physicians build less rapport with obese patients. Obesity (Silver Spring). 2013;21:2146-2152. Accessed December 5, 2015.

  23. Schwartz MB, Chambliss HO, Brownell KD, Blair SN, Billington C. Weight bias among health professionals specializing in obesity. Obes Res. 2003;11:1033-1039. Abstract

  24. Puhl RM, Luedicke J, Grilo CM. Obesity bias in training: attitudes, beliefs, and observations among advanced trainees in professional health disciplines. Obesity (Silver Spring). 2014;22:1008-1015. Abstract

  25. Schwartz MB, Vartanian LR, Nosek BA, Brownell KD. The influence of one's own body weight on implicit and explicit anti-fat bias. Obesity (Silver Spring). 2006;14:440-447. Abstract

  26. Penner LA, Dovidio JF, West TV, et al. Aversive racism and medical interactions with black patients: a field study. J Exp Soc Psychol. 2010;46:436-440.

  27. Hawker GA, Wright JG, Coyte PC, et al. Differences between men and women in the rate of use of hip and knee arthroplasty. N Engl J Med. 2000;342:1016-1022. Accessed January 4, 2016.

  28. Altemeyer B, Nunsberger B. Authoritarianism, religious fundamentalism quest, and prejudice. Int J Psychol Relig. 1992;2:113-133.

  29. Krosch AR, Berntsen L, Amdoio DM, Jost JT, Van Bavel JJ. On the ideology of hypodescent: political conservatism predicts categorization of racially ambiguous faces as black. J Exp Soc Psychol. 2013;49:1196-1203.

  30. Survey: ED physicians report burnout, desire help for dealing with frequent users. ED Manag. 2011;23:104-105. Abstract

  31. Hull SK, Broquet K. How to manage difficult patient encounters. Fam Pract Manag. 2007;14:30-34. Accessed January 3, 2016.

  32. Hill KP. Medical marijuana for treatment of chronic pain and other medical and psychiatric problems: a clinical review. JAMA. 2015;313:2474-2483. Abstract

Authors and Disclosures


Carol Peckham

Director, Editorial Services, Art Science Code LLC

Disclosure: Carol Peckham has disclosed no relevant financial relationships.

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