Causes of Burnout: 2013 vs 2015
Physicians who responded to the 2013 and 2015 Medscape surveys were given a list of possible burnout causes and asked to rank them in importance. The list was the same in both years, with physicians ranking these factors on a scale of 1 ("not at all important") to 7 ("extremely important"). Figure 4 shows the list of causes and the overall ranking in importance from this year's survey.
Too many bureaucratic tasks. In both years, "too many bureaucratic tasks" ranked first. Bureaucratic pressures and loss of autonomy are well-researched causes of stress in physicians. It is worth quoting Robert M. Wah, president of the American Medical Association: "Physicians want to provide our patients with the best care possible, but today there are confusing, misaligned and burdensome regulatory programs that take away critical time physicians could be spending to provide high-quality care for their patients."
Too many hours at work. "Spending too many hours at work" was listed as the second most important cause. In a 2007 study of ob/gyns, the strongest predictor of work-life balance and burnout was having control over their schedule and the hours they worked. A 2014 survey from the Physicians Foundation found that 81% of physicians were overextended or at full capacity, and only 19% had time to see more patients. In the same survey, 44% planned to reduce patient access to their service, either by cutting back on new patients, going part-time, or quitting clinical practice altogether. It should be noted, however, that this percentage is slightly lower than that found in the Foundation's 2008 survey, in which 49% planned to reduce patient load.
Insufficient income. "Income not high enough" as a cause of burnout increased from fifth place in 2013 to third this year, and income for most physicians is not likely to get better any time soon. The Affordable Care Act (ACA) had bumped up Medicaid rates by 40% or more through 2014, but these are expected to return to the previous base level (except in some states that will use their own funds to maintain the higher fees). The American Medical Association has also recently warned that the "'regulatory tsunami' facing US physicians could cut Medicare payments by more than 13% by the end of the decade." Worse, this year more than a quarter million physicians and other healthcare providers will be penalized 1% of their pay for failing to achieve meaningful use of their electronic health record (EHR) technology. "A physician can ace 99% of the requirements and still get penalized for flunking the remaining 1%," said Robert Wergin, MD, president of the American Academy of Family Physicians, in an interview with Medscape Medical News.
In this year's Medscape survey, physicians were asked whether they had sufficient savings and/or an unacceptable degree of debt for their stage in life. Internists, family physicians, and intensivists, who are among the most burned-out physicians, were also among the least confident in their financial status (Figure 5). Still, income—or at least a feeling of financial security—does not guarantee a burnout-free life. Except for ophthalmologists, the five most financially secure specialties (orthopedics, urology, ophthalmology, anesthesiology, and emergency medicine) were not among the five least burned-out specialties (dermatology, psychiatry, pathology, gastroenterology, and ophthalmology). In fact, emergency medicine physicians are the second most burned-out physicians. Money may bring a certain measure of happiness, but it doesn't make up for the other key factors contributing to burnout: the bureaucratic burden and the high patient load.
Increasing computerization. It comes as little surprise that one dramatic change from 2013 to 2015 in the list of important burnout causes was "increasing computerization of practice," which rose from ninth place in 2013 to fourth this year. In a 2014 Medscape survey of physicians, 70% said that the EHR decreased their face-to-face time with patients, and 57% noted that it detracted from their ability to see patients. According to the 2014 Physicians Foundation survey, although 85% of physicians have now implemented EHRs, only 32% say they have improved practice, and 46% say they have detracted from efficiency. There are, however, indications that computerization will become less of a problem. In the Medscape survey, 81% of respondents said they are becoming more comfortable with their EHRs over time. And in the Foundation survey, responses varied dramatically by age, with 42% of those under 45 reporting that EHRs have improved quality compared with 26% over 45. Women and PCPs were also more positive about EHRs (36% and 38%, respectively) compared with men and specialists (30% and 29%, respectively).
The impact of the ACA. Of interest, the ACA dropped from third place in importance to fifth this year among all physicians, although differences varied by specialty. For example, dermatologists and radiologists rated it second this year. And among those in primary care, family physicians ranked it at fifth place and internists at eighth place. In the 2014 survey from the Physicians Foundation, although the majority gave the ACA a negative grade, more female physicians gave the ACA a positive one (30.7%) compared with males (22.8%), and more PCPs (30.9%) than specialists (22.4%). But even if many physicians are ranking the ACA lower this year as a direct cause of burnout, certainly its fallout has increased the impact of the other important burnout causes: bureaucratic tasks, too many hours at work, insufficient income, and increasing computerization.
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Cite this: Physician Burnout: It Just Keeps Getting Worse - Medscape - Jan 26, 2015.