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At the Boiling Point: Physician Burnout & Work-Life Balance

At the Boiling Point: Physician Burnout & Work-Life Balance
Author Information (click to view)

Colin P. West, MD, PhD

Associate Professor of Medicine & Biostatistics
Department of Internal Medicine
Mayo Clinic

Colin P. West, MD, PhD, has indicated to Physician’s Weekly that he has or has had no financial interests to report.

Figure 2 (click to view)
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Colin P. West, MD, PhD (click to view)

Colin P. West, MD, PhD

Associate Professor of Medicine & Biostatistics
Department of Internal Medicine
Mayo Clinic

Colin P. West, MD, PhD, has indicated to Physician’s Weekly that he has or has had no financial interests to report.

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Burnout appears to be more common among physicians than among other workers throughout the country, particularly for those in specialties at the front line of care access.
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Previous research has indicated that many physicians throughout the United States experience professional burnout, a syndrome characterized by emotional exhaustion, depersonalization, and a low sense of personal accomplishment. Studies suggest that burnout can reduce quality of care and increase risks for medical errors, among other negative consequences. Furthermore, there are other adverse personal consequences for physicians that have been linked to burnout, including contributions to broken relationships, problematic alcohol use, and suicidal ideation (read guest blogger, Dr. Rob’s, Top 10 Burnout Triggers).

“We have limited data characterizing physician burnout, but few studies have evaluated rates of burnout among U.S. physicians nationally,” says Colin P. West, MD, PhD. “Previous investigations have speculated on which medical or surgical specialty areas are at higher risk, but these analyses have not been definitive.” He adds that research is also lacking on how rates of burnout for physicians compare with rates for U.S. workers in other fields.

Medical Specialty Matters in Burnout

In the Archives of Internal Medicine, Dr. West and colleagues published a study on burnout involving a large sample of U.S. physicians from all specialty disciplines using the American Medical Association Physician Masterfile. Surveys were used to assess the prevalence of emotional exhaustion, enthusiasm dissipation, cynicism, depression, suicidal tendencies, negative views on work-life balance, and low professional esteem among physicians.

After collecting responses from 7,288 physicians from various healthcare settings, 45.8% reported experiencing at least one symptom of professional burnout. “We observed substantial differences in burnout by specialty,” says Dr. West (Figure). The highest rates of burnout were seen in physicians at the front lines of care, most notably family doctors, general internists, and emergency physicians. In addition, the following was observed among surveyed physicians:

37.9% reported high levels of emotional exhaustion.
29.4% reported that cynicism was an issue.
12.4% reported having a low sense of personal accomplishment.

Importantly, Dr. West notes that not all physicians reported an equal tendency toward professional unhappiness. “Our findings suggest that while many of the medical community’s first responders were more likely to suffer from some form of burnout, others were less likely to experience such issues.” These specialists included dermatologists, pediatricians, and preventive medicine physicians.

Burnout Among Physicians vs General Workers

The study by Dr. West and colleagues also compared physician burnout data with survey data from 3,442 working Americans. In these analyses, physicians were more likely to have symptoms of burnout and to be dissatisfied with work-life balance than general workers (online exclusive Table). “It’s not surprising that many physicians are experiencing more stress than other U.S. workers because the healthcare system and consumers are increasingly putting higher demands and expectations on physicians,” Dr. West says. “The implications are important. These findings raise concerns about the negative impact physician distress can have on quality of care.”

Increasing Efforts to Find Solutions

With data showing that front-line physicians are experiencing greater distress than other working Americans, Dr. West says it is critical to target future research efforts on potential solutions for physicians. “When combined with positive changes in the healthcare environment, our findings emphasize the need to help physicians learn how to reach out to friends, family members, and work colleagues to get help when symptoms of burnout emerge.”

Medical and physician support programs are already in place in every state throughout the country and have reported many successes in helping physicians with burnout and other kinds of stress-related problems. The challenge, according to Dr. West, is that physicians—just like other people in general—often have trouble finding where to turn for help. Support systems are available for physicians, he says, but they must be encouraged to look at their own stresses, determine what kind of help they need, and feel comfortable reaching out for that help when it is needed.

With increasing evidence that physician burnout adversely affects quality of care, findings from the study by Dr. West and colleagues suggest that this problem threatens the foundation of the U.S. medical care system. “The problem of burnout won’t go away anytime soon as healthcare reform efforts are likely to increase demand for front-line care providers,” says Dr. West. “It’s important to remember that the origins of burnout are rooted in the environment and care delivery system rather than in the personal characteristics of a few susceptible people. Policy makers and healthcare organizations must address this problem for the sake of physicians and their patients.

Related Article!

Read Dr. Rob’s, Top 10 Physician Burnout Triggers

“Being a doctor is a privilege, but sometimes the pressures can turn the nicest doc into a jerk. Some of the things on my list are just part of the job, while others are caused by the ills of society and our ridiculous system.” – Dr. Rob 

Readings & Resources (click to view)

Shanafelt TD, Boone S, Tan L, et al. Burnout and satisfaction with work-life balance among US physicians relative to the general US population. Arch Intern Med. 2012;172:1377-1385. Available at: http://archinte.jamanetwork.com/article.aspx?articleid=1351351.

West CP, Shanafelt TD, Kolars JC. Quality of life, burnout, educational debt, and medical knowledge among internal medicine residents. JAMA. 2011;306:952-960.

Shanafelt TD, Balch CM, Bechamps GJ, et al. Burnout and career satisfaction among American surgeons. Ann Surg. 2009;250:463-471.

Wallace JE, Lemaire JB, Ghali WA. Physician wellness: a missing quality indicator. Lancet. 2009;374:1714-1721.

Dyrbye LN, Massie FS Jr, Eacker A, et al. Relationship between burnout and professional conduct and attitudes among US medical students. JAMA. 2010;304:1173-1180.

Shanafelt TD, Balch CM, Bechamps G, et al. Burnout and medical errors among American surgeons. Ann Surg. 2010;251:995-1000.

Shanafelt TD, Sloan JA, Habermann TM. The well-being of physicians. Am J Med. 2003;114:513-519.

Kuerer HM, Eberlein TJ, Pollock RE, et al. Career satisfaction, practice patterns and burnout among surgical oncologists: report on the quality of life of members of the Society of Surgical Oncology. Ann Surg Oncol. 2007;14:3043-3053.

2 Comments

  1. I ‘transitioned’ from my wonderful, highly successful and well-respected Ob-Gyn practice 15+ years ago. Not that I really wanted to stop practicing, but I was totally burnt out with the influx of managed–i.e., MANGLED–care and what I call the ‘raping’ of the medical profession.

    It has always galled me that we studied long and hard, work untold hours (especially when I trained and practiced, not like these young kid docs today), and we have to fight to get paid, or have to report to this or that to do what we know needs to be done. “NO, I’m NOT sending her home today,” was a frequent comment I had to make to [whoever] if a patient had a fever or something I didn’t like.

    I was already seeing a bunch of patients every day and I was NOT going to cut the time I spent with a patient to still make ends meet, despite insurance holdbacks, etc. I gave my patients the care they needed and deserved. It was written up in the local paper–two of them–when and why I stopped practicing.

    I miss my patients, my patients miss me. No lawsuits ever. I miss surgery so badly!! I’ve since been writing (published with Simon & Schuster, others), I lecture here and there, but nothing–NOTHING–compares to my first love–being the best darn doctor and ob-gyn I could be and for my patients to have. I’m not meeting my full potential nor my life’s calling at this point.

    It’s sad what has happened to our noble profession.

  2. I retired at 62 with too much to do, dwindling income, uncontrolled HTN, despite multiple drugs, and inability to provide for my patient group, head injury, quadriplegia, amputation, wit poor insurance, 82% no pay, medicaid , medicare despite their extensive needs. A quadriplegic, for example requires 1.5 hours to fully evaluate, 45% also have TBI, for less money than my overhead for the time needed. I loved my patients and the work. It was horrible to quit but it was too horrible to continue. I would not cut corners.

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