Loneliness, Burnout, and Other Types of Emotional Distress Among Family Medicine Physicians

Results From a National Survey

Samuel Ofei-Dodoo, PhD, MPA, MA; Rebecca Mullen, MD, MPH; Andrew Pasternak, MD, MS; Christina M. Hester, PhD, MPH; Elisabeth Callen, PhD, GStat; Edward James Bujold, MD; Jennifer K. Carroll, MD, MPH; Kim S. Kimminau, PhD

Disclosures

J Am Board Fam Med. 2021;34(3):531-541. 

In This Article

Abstract and Introduction

Abstract

Purpose: This study assessed the prevalence of loneliness, burnout, and depressive symptoms from a national sample of family medicine physicians.

Discussion: We conducted a cross-sectional survey of 401 physicians who were members of the American Academy of Family Physicians (AAFP) and AAFP National Research Network between December 7, 2019, and January 20, 2020. The study participants completed an anonymous, 30-item survey measuring loneliness, burnout, symptoms of depression, fatigue, in addition to providing demographic information.

Results: The response rates were 16.3% (401 of 2456) for all the physicians, 7.0% (113 of 1606) for the AAFP NRN member physicians, and 33.9% (288 of 850) for the AAFP member insight physicians. The prevalence of loneliness, burnout, and depressive symptoms was 44.9% (165 of 367), 45.1% (181 of 401), and 44.3% (163 of 368) respectively. The physicians who experienced a greater feeling of loneliness compared with those who experienced a lesser feeling of loneliness were more likely to report at least 1 manifestation of burnout (69.1% vs 27.4%, P < .01), screen positive for depression (66.0% vs 27.6%, P < .01), and experience a higher degree of fatigue (59.5% vs 32.4%, P < .01). Depressive symptoms (odds ratio [OR] = 5.08; 95% confidence interval [CI], 4.64–7.94; P < .001), overwhelming exhaustion (OR = 7.19; 95% CI, 4.03 to 12.02; P < .001), and burnout (OR = 4.61; 95% CI, 2.96–7.19; P < .001) were associated with loneliness status.

Conclusion: Our findings demonstrate that loneliness is common in practicing family medicine physicians and is significantly associated with burnout and depression. Future work is needed to understand the various interactions and relationships among loneliness, burnout, and depression to help inform effective interventions.

Introduction

Loneliness, defined as the internal perception of inadequate personal relationships,[1] poses a significant health concern. Loneliness is associated with a variety of negative physical and mental health conditions, such as hypertension, cardiovascular disease, stroke, depression, suicide, and even death.[2–4] The prevalence of loneliness has been cited as high as 35% in US adults above 45 years old.[5] Given these concerns, leaders in the field have called for loneliness to be deemed a public health priority in the United States.[6]

As a state of emotional discomfort, loneliness likely is related to other conditions of psychological distress such as burnout. Literature supports that over 50% of physicians experience symptoms of burnout, such as emotional exhaustion, cynicism, and reduced professional efficiency.[7–9] Burnout among health care providers is associated with increased medical errors,[10,11] dishonest clinical behaviors,[12] lower patient satisfaction,[13,14] and greater job turnover.[15] Similar to loneliness, burnout has been called a public health crisis in the United States.[16]

While there is literature that contributes to our understanding of burnout in health care providers, less is known about loneliness experienced by physicians and the relationship between loneliness and burnout. Loneliness is thought to be prevalent among physicians, with a Harvard Business Review study illustrating that those with professional degrees, such as physicians, have the highest rates of loneliness among all professions.[17] Previous research in a sample of physicians in Kansas illustrated that the prevalence of loneliness was 43% among respondents.[18] While loneliness has been linked to physician burnout,[18–22] this has not been demonstrated in a national sample of practicing physicians.

Given the known individual and systematic impacts of physician psychological distress, in addition to the relationship between physician well-being and quality of care,[23] it is important to learn about emotional stress experienced by physicians. A greater understanding of the national experience of physician loneliness, burnout, and other forms of emotional distress would allow for a more informed and generalizable discussion about individual and organizational approaches to mitigate negative impacts. This study aimed to assess the prevalence of loneliness, burnout, and depressive symptoms from a national sample of family medicine physicians.

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