MedScape: An Epidemic of Physician Burnout

Doctor with PatientAccording to Medscape's Physician Lifestyle Report, physicians are burned out and only getting more so.  And the most important cause of burnout - bureaucracy and spending too much time at work on administrative tasks.

Here are some excerpts from the recently-published Medscape study:

Compared with other American workers, US physicians suffer more burnout, according to a national survey.[1] Burnout is defined as loss of enthusiasm for work, feelings of cynicism, and a low sense of personal accomplishment. In Medscape's Physician Lifestyle Report 2013, 39.8% responded that they were burned out. This year that number went up: 46% reported burnout. An editorial published in the Journal of General Internal Medicine reported burnout rates ranging from 30% to 65% across specialties, with the highest rates of burnout incurred by physicians at the front line of care, such as emergency medicine and primary care physicians.[2] The 2015 Medscape survey results reflect this same pattern, with the highest burnout rates found in critical care (53%) and emergency medicine (52%), and with half of all family physicians, internists, and general surgeons reporting burnout.

Burnout has been shown to negatively affect patient care,[3] and many of the factors that lead to burnout are also associated with a higher likelihood of physicians leaving their practice.[2] Rates of suicide are higher in physicians than in the general population,[4] with studies indicating that job stress is a factor.[5] Medscape asked burned-out physicians to rate the severity of their burnout from 1 ("does not interfere with my life") to 7 ("so severe that I'm thinking of leaving medicine"). Of interest, specialties reporting the highest severity ratings (nephrology 4.30, cardiology 4.29, and plastic surgery 4.28) were not those with the largest percentage of burned-out physicians.

Bureaucracy and loss of autonomy are known causes of stress.[6,7] This report provides more evidence of the importance of these factors, with bureaucratic tasks and spending too many hours at work rated as the most frequent causes of burnout, with scores of 4.74 and 3.99, respectively, based on a scale of 1 ("not at all important") to 7 ("extremely important"). In fact, being able to control work hours is increasingly found to play an important role in reducing stress and, therefore, burnout among physicians.[7-9] This year, insufficient income (3.71) and computerization (3.68) were also found to be important causes of burnout. One study found that PCPs with the highest number of electronic medical record functions also experienced the highest amount of stress.[10] Of interest, the Affordable Care Act dropped to fifth place as a burnout cause this year, from third place in the 2013 Medscape report.

(1) 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.
(2) Linzer M, Levine R, Meltzer D, Poplau S, Warde C, West CP. 10 bold steps to prevent burnout in general internal medicine. J Gen Intern Med. 2014;29:18-20.
(3) Shanafelt T, Dyrbye L. Oncologist burnout: causes, consequences, and responses. J Clin Oncol. 2012;30:1235-1241.
(4) Hampton T. Experts address risk of physician suicide. JAMA. 2005;294:1189-1191.
(5) Dyrbye LN, Thomas MR, Massie FS, et al. Burnout and suicidal Ideation among U.S. Medical Students. Ann Intern Med. 2008;149:334-341.
(6) Jensen PM, Trollope-Kumar K. Building physician resilience. Can Fam Physician. 2008;54:722-729
(7) Keeton K, Fenner DE, Johnson TR, Hayward RA. Predictors of physician career satisfaction, work-life balance, and burnout. Obstet Gynecol. 2007;109:949-955.
(8) Tucker P, Bejerot E, Kecklund G, Aronsson G, Akerstedt T. The impact of work time control on physicians' sleep and well-being. Appl Ergon. 2015;47:109-116.
(9) Ruotsalainen JH, Verbeek JH, Mariné A, Serra C. Preventing occupational stress in healthcare workers. Cochrane Database Syst Rev. 2014 13;11:CD002892. [Epub ahead of print]
(10) Babbott S, Manwell LB, Brown R, et al. Electronic medical records and physician stress in primary care: results from the MEMO Study. J Am Med Inform Assoc. 2014;21(e1):e100-e106.

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