award icon Created with Sketch. calendar certificate clock icon Created with Sketch. E3102F58-39B7-46A0-8807-E0F8514AF64F Created with sketchtool. B48371CD-7E6B-424D-A27D-C47F740A4CE9 Created with sketchtool. graduation-cap-v2 BE74797F-D7BA-4121-9C80-10A96FDA86F0 Created with sketchtool. 0260AD13-A00B-4C10-833D-FC53567907CE Created with sketchtool. moneystack Created with Sketch. nib icon 12-5 Created with Sketch. resume icon Created with Sketch. E2B92C1B-84F1-409E-84D3-5740C0E9A496 Created with sketchtool.
Loading...Please Wait
The Dangers of Burnout for Doctors and Patients
How Burnout Can Affect Patients

Burned-out physicians can pose significant problems to themselves and to their patients. Whereas many physicians can function fairly well—albeit unhappily—while struggling with burnout, others are susceptible to and display a variety of harmful attitudes and behaviors.

These latter physicians tend to communicate less effectively with patients, which is a major concern. After all, medicine is about listening to your patients and connecting with them.

Burned-out physicians primarily just want to survive their day. They may be yearning to get out of the office as soon as possible, and may make little effort to try to listen to the patient. As a result of burnout, some physicians can seem impatient, irritable, curt, or snappish when dealing with a patient's legitimate questions. This directly leads to lower patient satisfaction.

Patients pick up on burnout. Some of them may give their doctors negative reviews on doctor-rating websites or look for a new doctor. A 2012 study found that patients of physicians exhibiting high exhaustion and high depersonalization had significantly lower patient satisfaction scores on surveys by insurers. [1] Poor patient satisfaction scores can cause a doctor to be deselected from the provider panel of a health plan.

More Medical Errors Could Occur

Even if patients stay with their doctor, they may become less cooperative, which can reduce the quality of care they receive. There is a 19% higher risk for nonadherence among patients whose doctors communicate poorly, according to a 2009 meta-analysis in Medical Care. [2]

Burned-out physicians have been linked to more medical errors and higher malpractice risks, and to suboptimal care. [3,4] It has also been shown that patients are less likely to sue physicians whom they think care for them. [5]

Burned-out physicians have been linked to more medical errors and higher malpractice risks.

In a review [6] of closed claims from 2005 to 2010 by The Doctors Company, a medical malpractice insurer owned by physicians, poor communication between doctor and patient was noted as a risk management issue in 40% of the cases.

Burnout could potentially add to the looming shortage of physicians. Older burned-out physicians are more likely to cut back on their hours or retire earlier. From 2008 to 2014, as burnout rates among physicians soared, there was a statistically significant increase in the proportion of male doctors older than 55 years who worked less than full time, a 2015 study found. [7]

The Impact on Doctors' Personal Lives

Turning to physicians' personal lives, burnout and other mental health concerns have been linked to a higher rate of car accidents, poor health, and weight gain. [8] Relationships with family and friends tend to suffer as well, as the burned-out doctor increasingly withdraws from social contact. Isolation only makes the situation worse.

Physicians' marriages, at least for female doctors, can be harmed by burnout. A 2011 study [9] closely linked work/home conflict with burnout in female physicians, and a 2015 study [1] linked longer work hours to higher divorce rates for female physicians.

Poor health is another offshoot of burnout. In general, physicians who are burned out are less vigilant about their health and pay less attention to healthy habits.

Burnout as a Serious Mental Health Issue

One symptom of burnout in doctors is negative feelings about their self-worth. If an exhausted doctor's less-motivated attitude prompts 1 in 5 patients to disregard the doctor's treatment regimen, it can exacerbate the doctor's lack of self-esteem.

Burnout is a serious mental health problem. Like other mental health problems, if it isn't addressed, it generally gets worse. It can lead to depression and self-destructive behavior, including an unkempt appearance; short temper; chronic tardiness; drinking too much; drug addiction; poor documentation; and violent outbursts, such as throwing medical instruments. It can even lead to suicide.

Addiction Can Be a Growing Problem

It's tempting for physicians to turn to self-medication to help relieve the stress and anxiety that come with burnout. Some burned-out physicians become addicted to alcohol and painkillers in an attempt to make themselves feel better or to dampen the effects of burnout. Because physicians typically have easy access to addictive painkillers, self-medication is an especially dangerous outlet for doctors.

It's tempting for physicians to turn to self-medication to help relieve the stress and anxiety that comes with burnout.

Among doctors treated in physician health plans, the most common primary drugs of abuse were alcohol (50%) and opioids (35%); the rest included stimulants, sedatives, and marijuana. [10] Because addicted physicians are likely to underreport their addiction, the real numbers may be much higher.

"Doctors get more into [narcotics] and sedatives," says J. Randle Adair, DO, an internist who has treated addicted doctors. "The drugs they're addicted to are more powerful, and they tend to come to treatment later." [11]

A 2013 study of doctors who sought treatment for addiction to painkillers reported that they took the drugs to manage physical pain, emotional or psychiatric distress, and stressful situations, among other reasons. [12]

Physicians who are addicted to drugs or alcohol pose a danger to patients as well as to themselves. Histories and physical examinations may be superficial and incomplete. Patients' conditions may be misdiagnosed because the physician-addict is unable to focus on what patients are saying about their symptoms. Necessary tests and imaging studies may not be ordered, and test results may be forgotten or misread. Prescriptions may carelessly specify the wrong medication or dosage, exposing patients to dangerous or even fatal side effects. Signs that a patient needs to be referred to a specialist or admitted to the hospital may be ignored.

Suicide, the Most Serious Outcome

Seriously burned-out physicians may find momentary relief through self-medication, but this doesn't treat the underlying problem; it only makes things worse. And because physicians often have unrestricted access to drugs of abuse, things can quickly spiral out of control, leading to a tragic outcome, according to a report by the American Foundation for Suicide Prevention. [13] The foundation reported that an estimated 300-400 US physicians die by suicide each year.

The rate of suicidal ideation (ie, having thoughts of committing suicide) among physicians aged 45 years or older was 1.5 to three times higher than in the general population in the same age range, the report found. There is a link between burnout and suicidal ideation among surgeons, according to a 2011 study. [14] People who talk about suicide, threaten suicide, or call suicide crisis centers are 30 times more likely than average to kill themselves. [15]

Physicians are more than twice as likely as nonphysicians to kill themselves, and female physicians are three times more likely than their male counterparts to commit suicide. [16]

Symptoms that may signal a need for help include verbal suicide threats, such as "You'd be better off without me" or "Maybe I won't be around"; expressions of hopelessness or helplessness; previous suicide attempts; daring or risk-taking behavior; personality changes; depression; giving away prized possessions; and lack of interest in future plans. [15] Any one of these symptoms doesn't necessarily mean that an individual is considering suicide, but when a doctor manifests several of these symptoms, alarm bells should go off.

Why Many Physicians Do Not Seek Help

Refusing to seek help is common among physicians experiencing burnout, addiction, depression, and suicidal thoughts. "Those suffering from burnout or depression often have pretty delusional thinking," said Mick Oreskovich, MD, a Seattle psychiatrist. [17] "They are going to work thinking that they're still doing a good job. They are often the last person in the room to know how depressed they are."

Unfortunately, physicians often feel uncomfortable talking to each other about their problems. Doctors tend to be independent thinkers who can solve problems without asking for help. They are often particularly unwilling to ask for help when dealing with personal problems, seeing it as a sign of weakness.

In addition, many physicians fear—in some cases justifiably—that if word got out that they were burned out, there could be professional repercussions, possibly even revocation of their licenses to practice medicine.

Some physicians have reported that answering "yes" to an employment or licensing question about past treatment for depression can be enough to trigger what one doctor described as a "Kafkaesque nightmare." [18]

So problems are kept bottled up inside. This prevents affected physicians from seeking a supportive environment where they could get help from each other. Simply knowing that you aren't the only doctor who is burned out can make it easier to enter recovery.

Simply knowing that you aren't the only doctor who is burned out can make it easier to enter recovery.

One internist noted, "When it comes to stress and burnout, physicians are either too busy to notice; too stoic to admit it; feel that they can handle it themselves; and/or are reluctant to seek outside help for fear of exposing a human weakness, potential questions about competency, or concerns about confidentiality." [19]

Burnout Means That Everyone Suffers

In summary, when physicians become burned out, everyone suffers. Burned-out doctors tend not to interact well with patients. As a result, the doctor/patient relationship may wither, prompting some patients to retaliate by not adhering to the regimens the doctor has prescribed, owing to lack of trust. The whole healthcare enterprise tends to collapse.

Physicians may not recognize that they are burned out, allowing their condition to worsen. Even when doctors do recognize that they are burned out, they may not seek help because they fear appearing weak or that they would jeopardize their careers if word got out about their behavioral problems. It's a vicious cycle, but there are ways to interrupt the cycle and take the path to recovery.

Review Questions
Next Chapter
Complete a self-assessment to earn a Medscape Academy Certificate or continue to Medscape Education to earn both a Medscape certificate and CME credit.
Earn Medscape Academy Certificate
Earn Medscape Academy Certificate
+ Credit
on Medscape Education
Earn Medscape Academy Certificate
View Course Certificate
View Course Certificate
Activity - Credits

Welcome! This article is part of a Medscape Physician Business Academy course, . Visit the Course Page to take the full course and receive a certificate.


Gabriel A. Sara, MD

| Disclosures | January 01, 2017

Authors and Disclosures


Gabriel A. Sara, MD

Assistant Professor of Medicine, Departments of Medicine, Hematology, and Oncology, Icahn School of Medicine at Mount Sinai; Medical Director, Infusion Suite, Division of Hematology/Oncology, Mount Sinai West, New York, New York

Disclosure: Gabriel A. Sara, MD, has disclosed no relevant financial relationships.