Study Finds ‘Alarming’ Physician Burnout Rate

August 22, 2012 - A growing number of physicians are experiencing burnout from their jobs, with sobering results. They lose enthusiasm for their work. They develop compassion fatigue and show signs of depression. They may even be more likely to make medical errors. Some seek early retirement or change careers. There are personal effects, too; some physicians turn to alcohol for solace, find themselves neglecting important personal relationships or even develop suicidal thoughts.

This is not a new phenomenon; in fact, the Journal of the American Medical Association(JAMA) and the Annals of Internal Medicine have published studies on physician burnout for more than a decade. But it continues to be a problem.

A new study published online on August 20 for the Archives of Internal Medicine found that burnout is at “an alarming level” among U.S. physicians. Not only is burnout more common among doctors than the general workforce in the United States, but physicians in certain specialty areas--notably the ones on the front line of care--are at the greatest risk for burnout.

The research team that authored “Burnout and Satisfaction with Work–Life Balance Among U.S. Physicians Relative to the General U.S. Population” compiled a sampling of physicians from all the specialty disciplines in the American Medical Association’s (AMA’s) physician master file, and sent out nearly 90,000 invitations. Then, they assessed the completed surveys from 7,288 physicians, using the Maslach Burnout Inventory, “the gold standard tool for measuring burnout.”

What they found: The research team found that just over 45 percent of the surveyed physicians reported at least one hallmark of burnout, which could include high emotional exhaustion, high depersonalization and a low sense of personal accomplishment. The specialties with the highest rates of burnout were emergency medicine, internal medicine, neurology and family medicine. The lowest burnout rates were found in doctors specializing in pathology, dermatology, general pediatrics and preventive medicine; these physicians tended to have a higher satisfaction with their work–life balance.

The high burnout rate among so many primary care providers isn’t surprising, given the current state of the health care system and all the recent changes that have happened, said Jeffrey Cain, MD, president-elect of the American Academy of Family Physicians (AAFP).

“Physicians are experiencing pressure, financially and otherwise,” said Cain. “And there is a lot of stress going on.”

For example, physicians in recent years have had to adapt to the implementation of electronic medical records (EMRs), and they’ve also had to cope with pressures to see more and more patients while receiving declining reimbursements.

Those pressures are significant, according to Heather Fork, MD, who works with physicians who are experiencing burnout.

“These doctors are not asking for the moon,” said Fork, who operates a coaching business called Doctor’s Crossing. “They just want to be able to have enough time with their patients, not have excessive administrative hassles and be able to go home and enjoy their families instead of worrying that they missed something on Mrs. Jones because they were rushing to meet their quota for the day.”

But it’s hard to avoid burnout. Fork also noted that doctors are taught to put their patients’ needs first. “It has created a mindset where it is hard for physicians to ask for help or acknowledge dissatisfaction,” she said. “There is a fear of appearing weak or not being able to cope as well as one’s colleagues that is pretty common.”

The study’s authors made the point that fundamental flaws in the current care delivery system may be responsible for the increasing prevalence of physician burnout.

“When considered with mounting evidence that physician burnout adversely affects quality of care, these findings suggest a highly prevalent and systemic problem threatening the foundation of the U.S. medical care system,” the authors wrote. “The fact that almost 1 in 2 U.S. physicians has symptoms of burnout implies that the origins of this problem are rooted in the environment and care delivery system rather than in the personal characteristics of a few susceptible individuals.”

But Cain expressed hope in the form of the patient-centered medical home model, or PCMH. This particular model of care delivery, which is gaining traction nationally, rewards physicians for spending more time with patients and leads to improved outcomes.

In the meantime, physicians could take steps toward helping themselves by taking the advice they often give to their patients, Cain said. Eat a healthy diet, get enough sleep, rest when you need rest and look beyond what Cain calls “the office treadmill.”

“It’s ‘Physician, heal thyself,’” he said. “It’s about taking care of yourself and taking care of your practice at the same time.”