Professional burnout among US physicians has reached a dangerous level, with more than half of physicians affected, according to the results of a 2014 national survey across various medical specialties and practice settings. Compared with responses from a similar survey in 2011, burnout and satisfaction with work–life balance have worsened dramatically, even though work hours have not increased overall.
"American medicine is at a tipping point," lead author Tait D. Shanafelt, MD, from the Mayo Clinic's Department of Internal Medicine in Rochester, Minnesota, told Medscape Medical News. "If a research study identified a system-based problem that potentially decreased patient safety for 50% of medical encounters, we would swiftly move to address the problem. That is precisely the circumstance we are in, and we need an appropriate system level response."
Dr Shanafelt and colleagues published the survey results in the December issue of the Mayo Clinic Proceedings.
They stress that interventions must address the organizational drivers of burnout in the practice environment, such as inefficiencies, the administrative burden, and inflexibility, and should not focus exclusively on self-help solutions, such as physician self-care or resilience training.
The researchers invited 35,922 physicians to respond to their questionnaire. Of these, 6880 (19.2%; 67.5% men; median age, 56 years) completed the survey between August 2104 and October 2014. Dr Shanafelt and colleagues compared the results with those from the 2011 survey and with those for a probability-based sample of working adults in the general population surveyed during the same period.
Burnout rates, depressive symptoms, suicidal ideation in the last 12 months, and satisfaction with work–life balance were among the measured characteristics.
Evaluated with the Maslach Burnout Inventory, 54.4% of physicians reported at least one symptom of burnout in 2014 compared with 45.5% in 2011 (P < .001). Satisfaction with work–life balance also declined during the 3 years, to 40.9% vs 48.5% in 2011 (P < .001).
Differences emerged by physician specialty, however: compared with 2011, burnout was higher in 2014 across all disciplines, with many climbing more than 10% in the 3-year interval.
|Family medicine||51.3%||63.0%||P < .001|
|General pediatrics||35.3%||46.3%||P = .005|
|Urology||41.2%||63.6%||P < .001|
|Orthopedic surgery||48.3%||59.6%||P = .01|
|Dermatology||31.8%||56.5%||P < .001|
|Physical medicine and rehabilitation||47.4%||63.3%||P = .01|
|Pathology||37.6%||52.5%||P = .006|
|Radiology||47.7%||61.4%||P = .003|
|General surgery subspecialties||42.4%||52.7%||P = .005|
Factors independently associated with both burnout and satisfaction with work–life balance included age, sex, specialty, hours worked per week, and practice setting. Women physicians had a higher burnout risk than their male colleagues (odds ratio, 1.29; P < .001), perhaps because of their overall younger age, Dr Shanafelt told Medscape Medical News.
On the measure of work–life balance, satisfaction declined in 2014 for all specialty disciplines except obstetrics/gynecology and general surgery.
In contrast, working adults in the general population experienced only minimal changes in burnout or work–life balance satisfaction between 2014 and 2011 (28.4% vs 28.6%; P = .85).
After multivariate adjustment for age, sex, marital/partnership status, and workweek, physicians faced an almost twofold greater risk for burnout (odds ratio, 1.97; 95% confidence interval, 1.80 - 2.16; P < .001) compared with nonphysician working adults.
In addition, 46.9% of physicians had a high score for emotional exhaustion, 34.6% had a high score for depersonalization, and 16.3% had a low score for personal accomplishment. Just 40.9% of practitioners said their schedules left sufficient time for personal and family life.
Only minimal differences were noted between 2011 and 2014 in respondents reporting symptoms of depression (39.8% vs 38.2%; P = .04). There was no difference in the rates of suicidal ideation, which held at 6.4% for both years (P = .98).
Dr Shanafelt and colleagues note that although students begin medical school with superior mental health profiles relative to graduates entering other fields, 1 or 2 years' medical study reverses this psychological situation, and once they begin to practice, "physicians have generally high degrees of satisfaction with their career choice but experience high degrees of burnout and dissatisfaction with work-life integration."
The work was financially supported by the Mayo Clinic Program on Physician Well-being. Dr. Shanafelt is coinventor of the Physician Well-being Index. The authors have disclosed no relevant financial relationships.
Mayo Clin Proc. 2015;90:1600-1613. Abstract
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Cite this: Physician Burnout Climbs 10% in 3 Years, Hits 55% - Medscape - Dec 01, 2015.