US Physicians Suffer More Burnout Than Other Workers

August 22, 2012 — Physicians in the United States suffer from more burnout than other workers in the United States, new research shows.

A national survey of more than 7000 US physicians reveals that close to one half report having at least 1 symptom of burnout.

"The fact that almost 1 in 2 US physicians has symptoms of burnout implies that the origins of this problem are rooted in the environment and care delivery system rather than in the personal characteristics of a few susceptible individuals.

"Policy makers and health care organizations must address the problem of physician burnout for the sake of physicians and their patients," the authors, led by Tait D. Shanafelt, MD, Mayo Clinic, Rochester, Minnesota, write.

The survey findings were published online August 20 in the Archives of Internal Medicine.

First National Study

Extensive data on physician burnout have been published, but to the investigators' knowledge, no national study has yet evaluated rates of burnout among US physicians or explored differences in burnout by specialty.

Burnout among US physicians has also not been previously compared with burnout among US workers in other fields. Dr. Shanafelt and colleagues therefore conducted a national study of burnout among physicians from all specialties using the American Medical Association Physician Masterfile.

Responses from 7288 physicians were compared with those of a sample of 3442 working adults from the general population.

As assessed by the Maslach Burnout Inventory, 37.9% of surveyed physicians exhibited high levels of emotional exhaustion, and 29.4% showed evidence of a high level of depersonalization. In addition, 12.4% had a low sense of personal accomplishment.

Taken together, investigators found that 45.8% of physicians were experiencing at least 1 symptom of burnout, based on a high emotional exhaustion score or a high depersonalization score. More than 6000 of the physicians surveyed were also compared with 3442 control participants who were working in the United States but not as physicians.

On burnout measures, physicians were more likely to have signs of emotional exhaustion compared with population control participants (32.1% vs 23.5%), depersonalization (19.4% vs 15%), and overall burnout (37.9% vs 27.8%; P < .001 for all comparisons).

Comparison of Employed MDs and Employed US Population

	Physicians (n = 6179)	Population Control Participants (n = 3442)
Emotional exhaustion: high score	32.1%	23.5% (P < .001)
Depersonalization: high score	19.4%	15% (P < .001)
Burned out	37.9%	27.8% (P < .001)
Satisfaction with work-life balance ("work schedule does not leave enough time for my personal or family life")	40.1%	23.1% (P < .001)

Burnout by Specialty

"Substantial" differences in burnout were also observed among different specialties.

Burnout rates were highest among physicians on the front line of care access, including family medicine, general internal medicine, and emergency medicine. It was lowest among pathologists, dermatologists, general pediatricians, and those practicing preventive medicine.

Differences between specialties were also documented with regard to satisfaction with work-life balance. Again, those practicing dermatology, general pediatrics, and preventive medicine had the highest rates for satisfaction with work-life balance, whereas those practicing general surgery, general surgery subspecialties, and obstetrics/gynecology had the lowest rates.

Dissatisfaction with work-life balance was also slightly higher among female physicians than among their male counterparts, whereas it was similar for men and women among control participants in the US population. Unlike fields outside of medicine, in which higher levels of education and professional degrees seem to reduce the risk for burnout, having a degree in medicine increased the risk, the investigators add.

On multivariate analysis, the number of hours worked per week was associated with a higher probability of burnout, whereas being older and being married were both significantly associated with a lower overall risk.

"Two consistent factors that seem to be driving burnout are lack of control or autonomy and loss of meaning in what physicians do," coinvestigator Colin West, MD, PhD, who is also from the Mayo Clinic, told Medscape Medical News.

For example, respondents cited indirect clinical tasks as getting in the way of the physician-patient relationship — forms to fill out, dictation, endless paperwork — "all of which take a heavy toll that has gotten heavier in the past 10 years," Dr. West added.

"We don't have a good understanding of what is leading to the loss of meaning," he noted. But clearly, physicians who lose sight of the ideals that propelled them into medicine in the first place are the ones "at great risk" for being dissatisfied, he noted.

"Patients say they are dissatisfied because physicians spend so little time with them, but beyond the face-to-face visit, the reality is that there are so many other tasks that must be taken care of, and physicians have to get them done," Dr. West said.

"We don't yet know whether coming healthcare reforms will make this better or worse, but regardless of what shape healthcare reforms end up taking, there will be increased demand on frontline providers, which is the very group we've identified as being under the most strain already, so we have to be mindful of future risks," said Dr. West.

Charles Balch, MD, University of Texas Southwestern Medical Center in Dallas, told Medscape Medical News that results from this survey of physicians from a variety of specialties are the same as what has been found in multiple surveys of surgeons.

"It's clear that physicians of all specialities do incur stress that is inherent to their profession, and some have a higher level of stress and burnout than others," he said. For example, in their survey of surgeons, they found that levels of stress were slightly higher for surgeons in private practice, but the stressors were different from those in academia.

"Part of the message from this survey is that physicians and the groups they work for, including hospitals, need to be proactive for mitigating the risk of burnout and its adverse consequences, including drug and alcohol use, early retirement, medical errors, malpractice, and so forth. So physicians need to take care of themselves and address their personal health needs, especially those at the higher end of stress and burnout, and be proactive about their health."

Funding for the study was provided by the American Medical Association and by the Mayo Clinic Department of Medicine Program on Physician Well-Being. The authors have disclosed no relevant financial relationships.

Arch Intern Med. Published online August 20, 2012. Full article