Physician Burnout: Expanding the Scope of Solutions
Reducing burnout is critical for physicians’ wellbeing and for the delivery of appropriate patient care.
Despite growing awareness of physician burnout in recent years, the problem has continued to increase. Burnout affects medical students, residents, and practicing physicians, with an estimated prevalence of 30% to 68%, and the negative impact extends to patients, coworkers, healthcare systems, and clinicians' family and friends.1,2
Professional burnout is a “syndrome defined by the triad of emotional exhaustion, depersonalization, and low sense of personal accomplishment related to one's work,” according to a review published in October 2017 in the Annals of Thoracic Surgery.3 John J. Squiers, MD, of the Heart Hospital Baylor Plano in Plano, Texas, and colleagues note that burnout is most commonly assessed with the Maslach Burnout Inventory, which includes self-report questions (answered on a 7-point Likert scale), such as “I feel fatigued when I get up in the morning and have to face another day on the job,” and “I feel I'm positively influencing other people's lives through my work.”
Risk Factors and Consequences
Although burnout affects individuals across career fields, higher rates have been found among physicians compared with other working adults in the United States (38% vs 28%). Prevalence also varies across specialties: the highest rates have been observed among emergency medicine and primary care doctors (60% to 70% and 50% to 60%, respectively), while lower rates have been noted among dermatologists and pediatricians (30% to 40% for each).4
Burnout has been linked with depression and suicidal ideation among physicians. In a 2011 study of 7905 surgeons, 1 in 16 had experienced suicidal ideation in the previous year, which was shown to be significantly associated with burnout (odds ratio [OR], 1.910; P <.001) and depression (OR, 7.012; P <.001).5
The new review identifies factors associated with increased risk for burnout among physicians, including younger age, being a parent, chosen subspecialty, number of hours worked per week and number of nights on call, and billing-based compensation.6,7 “Interestingly, seemingly positive character traits, including dedication, conscientiousness, responsibility, and motivation, appear to put physicians at increased risk for burnout, possibly because individuals possessing these characteristics may not experience work satisfaction that meets their idealistic and perfectionist qualities,” Dr Squiers and his colleagues note.
In addition to protecting physicians' well-being, reducing burnout is critical for the delivery of appropriate patient care. A strong independent correlation has been demonstrated between increased burnout and higher risk for medical errors. In research published in 2013, more than 15% of surgeons with high levels of burnout reported at least 1 major medical error within the preceding 3 months.8
Despite the related risks posed to all involved, much of the research to date has explored the prevalence of burnout rather than preventive or treatment solutions. Additionally, many initiatives designed to address burnout tend to place the burden on the physician to help manage stress — for example, by fostering “resilience” in physicians.
“Rather than simply enduring stress, a resilient individual uses ‘strategic stopping' that allows for recharging rather than continuing to endure additional stress,” wrote Dr Squiers and colleagues. Factors that have been shown to promote resilience include: individual factors such as positive coping and physical fitness, family factors such as communication and closeness, organizational factors such as teamwork and positive command climate, and community factors such as belongingness and cohesion.9