Change in Physician Burnout Between 2013 and 2020 in a Major Health System

Kathryn A. Martinez, PhD, MPH; Amy B. Sullivan, PsyD; Debra T. Linfield, MD; Victoria Shaker, BS; Pei-Chun Yu, MS; Michael B. Rothberg, MD, MPH

Disclosures

South Med J. 2022;115(8):645-650. 

In This Article

Abstract and Introduction

Abstract

Objective: Assessing changes in physician burnout over time can offer insight into the causes of burnout. Existing studies are limited by using different samples of physicians at each time point. Our objective was to assess changes in burnout between 2013–2014 and 2019–2020 overall and within a cohort of physicians who took the survey twice.

Methods: This is a longitudinal cohort and cross-sectional study of physicians in a major health system. They were administered the Maslach Burnout Inventory in 2013–2014 and 2019–2020. We separately assessed differences in odds of burnout and its subscales in 2013–2014 and 2019–2020 by physician characteristics and clinical time. We then assessed differences in the odds of reporting burnout and its subscales in 2019–2020 compared with 2013–2014 overall and by physician sex, race, and change in clinical full-time employment.

Results: There were 1220 respondents in 2013–2014, 503 in 2019–2020, and 149 who responded at both time points. Burnout increased from 35% to 56%. Compared with 2013–2014, physicians had 2.39 higher odds (95% confidence interval [CI] 1.92–2.98) of burnout in 2019–2020, and this change in burnout was significantly more pronounced for female versus male physicians (odds ratio 1.80; 95% CI 1.57–1.80). Compared with White physicians, non-White physicians had significantly lower odds of burnout at both time points, but their odds increased significantly more over time (odds ratio 1.36; 95% CI 1.05–1.57).

Conclusions: We found a substantial increase in burnout over time, which was particularly pronounced for non-White and female physicians. Assessment over time is essential for understanding problematic trajectories of burnout that may be obscured by cross-sectional studies.

Introduction

Physician burnout is common and has negative consequences for physicians, ranging in severity from job dissatisfaction to relationship dysfunction and even suicide. It also may put patient safety at risk, as burnout is associated with medical errors.[1,2]

In 2012, Shanafelt and colleagues published the first national survey of physician burnout, finding that 46% of physicians reported at least one symptom of burnout.[3] This article received widespread media attention, galvanizing physician and hospital groups to seek strategies to ameliorate burnout. Both individual and systems-focused interventions have shown some promise in reducing physician burnout.[4] Unlike depression, which affects all areas of life, burnout is specific to one's workplace,[5] suggesting that physician-level interventions, such as building resiliency,[6] alone are likely inadequate. A recent study of both individual and health system-level interventions to address burnout concluded that health system level changes are necessary.[7]

Potential sources of burnout at the health system level are manifold, and include burdensome documentation, challenges with billing, and expectations for increased productivity.[8,9] For this reason, physicians' experience of burnout is unlikely to be static over time. A national survey of physician burnout found that it declined between 2011 and 2017;[10] however, a survey of burnout over time at Massachusetts General Hospital found that it increased from 40% to 45% between 2013 and 2017.[11] National data can therefore obscure important trends within healthcare organizations, making it more difficult to understand the root causes of burnout.

Moreover, an important limitation of studies of population-based changes in physician burnout is the inability to control for selection. Because the population of respondents is not the same at both time points, it is impossible to know whether observed changes are at least partially attributable to differential physician response. To overcome this limitation, it should be assessed in the same physicians at multiple time points. To date, this has not been done.

In 2013–2014, we assessed burnout within the Cleveland Clinic Health System, finding that 35% of physicians met the criteria for burnout.[12] In 2019–2020 we had the opportunity to assess physician burnout again. The objective of our study was to assess changes in burnout during this period using the same sample of physicians at both time points.

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