Bias, Burnout, Race: What Physicians Told Us About the Issues

Carol Peckham

Disclosures

January 10, 2017

In This Article

Causes of Burnout

Physicians were asked to rate causes of their burnout on a scale of 1 to 7, where 1 equals "Does not contribute at all" and 7 equals "Significantly contributes."

The burden of bureaucracy. Topping the list, with an average rating of 5.3, was "too many bureaucratic tasks," followed by "spending too many hours at work," at 4.7. These two factors ranked highest among both men and women and were also highest in the past two surveys as well. And the ratings for these factors as important causes of burnout have been trending up. When this question was asked for the 2015 report, those factors were rated 4.7 and 4.0, respectively. "Feeling like just a cog in a wheel" and electronic health records (EHRs) also rated high this year (4.6 and 4.5, respectively) as causes of burnout.

In an October 2016 Medscape roundtable discussing EHRs and burnout, one of the panelists, Robert W. Brenner, MD, said, "If [EHR requirements are] implemented without a change in the workflow in the office, too much data entry falls on the physician. That is what is adding to the huge burden." Authors of a 2016 report in the Journal of Family Medicine went further[11]: "The evidence is compelling that the EHR and related regulatory requirements are playing a role in dehumanizing our profession." They offered possible solutions for reducing the burden imposed by the EHR, including process redesign and organizational changes. In line with this, in a 2016 Medscape interview, Christine A. Sinsky, MD, vice president of professional satisfaction at the AMA, discussed a new AMA program, STEPS Forward, which is intended to significantly reduce burnout by re-engineering workflow to remove unnecessary tasks and to find other ways of performing needed ones.[12]

Emotional issues. Initiatives to address emotional issues involved with burnout may also be important. One interesting study reported two significant factors leading to burnout in emergency medicine physicians: worry and a lack of existential meaning derived from work.[13] A 2016 systematic review in The Lancet identified a number of effective interventions that included not only organizational changes, such as limiting duty hours and changes in care delivery processes, but also mindfulness, stress management, and small group sessions as well.[14]

This year's Medscape Lifestyle Report found a pronounced negative effect of burnout on physicians' happiness both at work and outside the workplace. The survey, as in previous years, asked respondents to rate their happiness on a scale of 1 to 7, with 1 being "extremely unhappy" and 7 being "extremely happy. While well over half (59%) of physicians with no burnout claimed to be very or extremely happy at work, only 7% of their burned-out peers reported the same, a nearly eightfold difference. Burnout also affected happiness outside of work, with nearly three quarters (74%) of non-burned-out versus slightly less than half (48%) of burned-out physicians reporting being very or extremely happy outside the workplace.

When stratified by specialty, the same dichotomy applied, with very few burned-out physicians in any specialty (range, 2%-13%) claiming to be very to extremely happy at work (Figure 2). The range for those who were not burned out was 45%-69%. The highest percentage of physicians reporting being happy and not burned out was seen in dermatologists (69%), who also were the second happiest group (12%) among those reporting burnout. The highest percentage of burned-out physicians who reported that they were happy at work was found in intensivists, but it was only 13%. They were third from the bottom in happiness scores among their non-burned-out peers (48%).

Figure 2. Physician burnout and happiness at work.

Debt and burnout. The current survey did find some association between burnout and levels of debt (Figure 3). About a quarter (24%) of burned-out physicians were debt-free compared with 32% who are not burned out. For 12% of burned-out physicians, this debt was described as unmanageable, compared with only 5% of their non-burned-out peers. Although association is not causation, a 2011 study of internal medicine residents also found burnout to be associated with higher debt, and as the debt load increased, so did emotional exhaustion and depersonalization, key factors in burnout.[15]

Figure 3. Burnout and debt.

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