Physician Burnout: An Epidemic

physician-burnout
From supersmarthealth.com

Burnout among physicians is an under appreciated, expanding and potentially disastrous issue in healthcare. Defined as a pathologic response to stress, it is manifested by a classic triad of symptoms:

  • Emotional exhaustion
  • Depersonalization
  • Diminished sense of personal accomplishment

These particular symptoms certainly aren’t unique to the physician – some would say that these symptoms are already prevalent in American workers, and creating a crisis. However, studies have shown that doctors are at particular risk compared to the general public.

A 2011 study in Archives of Internal Medicine noted a 45.8% rate of burnout symptoms in physicians. In comparison to working U.S. adults, the study found physicians to be statistically more likely to experience burnout (p<0.001). This is true in spite of the fact that in areas outside of medicine, increasing education seems protective of burnout (T. D. Shanafelt et al. 2012). More concerning, this malady seems to be increasing. The authors of the 2012 study repeated their survey in 2014 and found that the rate of burnout has increased to 54.4% and satisfaction with work-life balance has declined significantly as well (T. Shanafelt et al. 2015).

 

Risks of Burnout

So what? Doctors hate their jobs just a little more commonly than the rest of us? What difference does it make?

A lot, it turns out.

Let’s consider their professional experience and their personal lives separately. At work, many negative impacts are noted, of which are of concern for patients.

  • Dissatisfaction with career choice (OK, that’s common)
  • Increased medical errors (Oh, oh – now, I’m listening)
  • Leaving medicine at a younger age (Depriving patients of experienced docs – not good)
  • Decreased commitment (Do you want to hear this about the person taking care of your illness?)
  • Poorer judgment (No comment needed)
  • Hostility & a negative attitude (Experienced by many of us at the hands of doctors already, right?)
  • Increased errors (Badness evident)
Medical Errors cartoon
From howardluksmd.com

On a personal level, the doctor can experience depression (30% incidence among surgeons according to a 2009 study (T. D. Shanafelt et al. 2009)), sleep deprivation, alcoholism and other addictions, withdrawal from family along with greater conflicts with spouses/partners, poorer health, and, most concerning, increased risk for suicide (Gold, Sen, and Schwenk 2013).

Causes of Burnout

Why is burnout such an epidemic among today’s physicians? There are many reasons, according to a 2013 survey of physicians reported in Medscape (Peckham and Stelka 2013):

  1. Too many bureaucratic tasks (The increased utilization of EMR is one such task that in and of itself seems to be contributing to burnout per a Chicago Tribune article in December, 2015)
  2. Present and future impact of ACA (This is a 2013 study, so this issue may be looked at differently now)
  3. Spending too many hours at work
  4. Feeling like just a cog in the wheel
  5. Increasing computerization of practice
  6. Lack of professional fulfillment

Surgeons in particular are felt to have some unique stressors compared to other specialties, especially those surgeons involved in trauma work. They work long hours, have frequent call nights, often don’t have much control over their schedule, find inadequate resources and inability to access the operating room at their hospitals, and run the risk of surgical complications. Factors related to increased burnout scores in surgeons according to Shanfelt’s 2009 article include:

  • Younger Age
  • Having children
  • Number of nights of call per week
  • Hours worked per week
  • Having compensation based only on billing

 

What Can Be Done About Physician Burnout?

There are many alternatives, though none have been studied for their successful outcomes rigorously.

Self-Treatment

Physicians often attempt to self-treat their own burnout. Most common techniques are participating in exercise programs, spending more time with family, taking time off for vacations, watching movies, listening to music, reading or trying to get more sleep. Although these make sense intuitively, the amounts required and effects have not been documented.

Organizational Efforts

Many healthcare organizations have realized the significance of this issue and attempted their own solutions. These include workshops and education, onsite exercise facilities and classes, Employee Assistance Programs and counseling. The problem with these from the physician’s view is that these efforts are generally only available during the day, when a physician’s time is at a premium.

 General Principles In Support of Burnout Victims

It seems there are 3 principles that most experts agree can help combat burnout and stress:

  1. More time – physicians simply need to build in more time in their lives for what is important to them. And to have more control over their time.
  2. More opportunities for self-care – such as exercise and other wellness interests.
  3. More support – to help them deal with burnout and stress. This is a complex, but consistent, thread found in interviewing doctors. Not just things like mentors, collegial support, and educational opportunities, but also support, respect and recognition from their administration.

 

CEO thumbs up
From Hot Lard Blog

 

So What Can I Do Right Now?

  • Limit call nights – some suggest 2 nights per week/8 nights per month maximum in trauma, where call is an essential part of the job. Even if the young doc wants to get paid for more – don’t let them!
  • Incentives
    • For exercise programs
    • For weight loss
    • For health counseling
    • And don’t forget the power of teams – group exercise/weight loss/activities on a regular basis help doctors connect in a different way at work.
  • Formal mentorship programs – for ALL doctors, not just the young ones
  • Regular collegial interaction – either informal/social or work-related
  • Flexibility – Administrators should work with docs to identify how more flexibility can work to benefit both of them
    • Does your practice need more evening hours? Maybe one doc wants to do that and come in later in the morning.
    • How about early hours – see patients at 6:30 before patients have to go to work? This might allow Dr. Smith to pick his kids up from school.
    • Signing up for clinical time in blocks in a rotating basis, rather than having the same schedule day after day, month after month, year after . . . you get the idea.
  • Changing models of care
    • For surgeons, can they take call several days at a time and not do elective/clinic practice during those days?
    • Even better: establishing a formal hospitalist program for surgeons – both general and orthopaedic – can lead to improved satisfaction for both the one doing the hospitalist work as well as the docs who don’t have to do call anymore.

 Our Biggest Challenge

Here’s the key, folks – we have to not just work to prevent burnout. We have to recognize it in ourselves and others. If you notice one of your formerly chipper doctor friends seems tired all the time, always seems to have a negative attitude, feels and looks hopeless – get your friend hat on! Talk to them about what you observe. And help them get help. Be a rock for them.

And if you feel that way right now? Get thee to a colleague, your hospital’s HR department, a mental health professional, or someone asap. Don’t wait until your burnout leads to a patient mishap that will define the rest of your life.

Bibliography

Gold, Katherine J., Ananda Sen, and Thomas L. Schwenk. 2013. “Details on Suicide among US Physicians: Data from the National Violent Death Reporting System.” General Hospital Psychiatry 35 (1): 45–49. doi:10.1016/j.genhosppsych.2012.08.005.

Peckham, Carol, and Bret Stelka. 2013. “Orthopedist Lifestyles – Linking to Burnout: Medscape Survey.” Medscape survey. Medscape. http://www.medscape.com/features/slideshow/lifestyle/2013/orthopedics?src=wnl_edit_specol.

Shanafelt, Tait D., Charles M. Balch, Gerald J. Bechamps, Thomas Russell, Lotte Dyrbye, Daniel Satele, Paul Collicott, Paul J. Novotny, Jeff Sloan, and Julie A. Freischlag. 2009. “Burnout and Career Satisfaction among American Surgeons.” Annals of Surgery 250 (3): 463–71. doi:10.1097/SLA.0b013e3181ac4dfd.

Shanafelt, Tait D., Sonja Boone, Litjen Tan, Lotte N. Dyrbye, Wayne Sotile, Daniel Satele, Colin P. West, Jeff Sloan, and Michael R. Oreskovich. 2012. “Burnout and Satisfaction with Work-Life Balance among US Physicians Relative to the General US Population.” Archives of Internal Medicine 172 (18): 1377–85. doi:10.1001/archinternmed.2012.3199.

Shanafelt, Tait, Omar Hasan, Lotte Dyrbye, Christine Sinsky, Daniel Satele, Jeff Sloan, and Colin West. 2015. “Changes in Burnout and Satisfaction With Work-Life Balance in Physicians and the General US Working Population Between 2011 and 2014.” Mayo Clinic Proceedings 90 (12): 1600–1613.

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