Bureaucracy, Long Hours Add to Rheumatologist Burnout

Janis C. Kelly

April 02, 2013

Rheumatologists have relatively low levels of burnout compared with emergency physicians and critical care physicians, but more than 35% (75/213) of them still reported symptoms of burnout, according to the 2013 Medscape Physician Lifestyle Report . The burnout symptoms included loss of enthusiasm for work, feelings of cynicism, and/or a low sense of personal accomplishment.

Rheumatologists were most plagued by bureaucratic tasks, hours spent at work, concern about the present and future effects of the Affordable Care Act, and insufficient income. Nearly half of the rheumatologists reporting burnout had severity scores above the mean of 3.6, but only 2 (3%) reported burnout "so severe I am thinking of leaving medicine altogether."

Rheumatologists reporting that they were not experiencing burnout were twice as happy with life outside of medical practice as those reporting burnout (30% vs 15% were "very happy" with life outside work). Interestingly, life at work was "very unhappy" for 1% of the total 213 rheumatology respondents, but this included none (0%) of the 75 burned-out rheumatologists and 3% of the 138 rheumatologists who were not burned-out.

Most physicians in both groups described themselves as in good or excellent health, but the rheumatologists who were not burned-out hit the gym more often: 36% exercised 4 or more times per week compared with 23% of the burnouts, and only 3% of those who were not burned-out reported that they never exercise compared with 11% of the burnouts.

The rheumatologists reporting burnout were surveyed about specific stressors. Scores ranged from 1 (not at all important) to 7 (extremely important).

"Too many bureaucratic tasks" led the list, with a mean score of 5.9. Thirty-two physicians (43%) rated it as an extremely important factor in burnout, and 55 (73%) reported scores above the mean for this item.

Eighty-eight percent of rheumatologists in each group rated "spending time with family" as their most rewarding pastime, which might be why "too many hours at work" was the second biggest factor in burnout, with a mean score of 4.8.

Worry about the present and future effects of the Affordable Care Act tied with "income not high enough" for third place as burnout factors, both with mean scores of 4.7. The stress of increased computerization of rheumatology practice tied for fourth place with "feeling like a cog in a wheel," both with scores of 4.6.

Difficult colleagues or staff, difficult employers, and "compassion fatigue" were not very important as stressors. Too many difficult patients was an "extremely important" stressor for 16% of burnouts, and inability to provide patients with the quality care they need was an "extremely important" stressor for 12%.

Many, but not all, of these hardworking rheumatologists take regular vacations. Nearly half take regular 2- to 4-week vacations each year, 12% of the burnouts and 5% of those who were not burned-out reported taking less than 1 week per year, but 1% of the burnouts and 3% of those who were not burned-out reported taking no vacations at all. The favorite vacation choice was foreign travel.

Female rheumatologists were slightly more likely to report burnout than males, and more than half of the burned-out rheumatologists were aged between 46 and 65 years.