MD burnout at 'alarming' level, part 1

Physician burnout is pervasive and prevalent, and few organizational interventions to address the high burnout rate have been developed, according to a study published in Archives of Internal Medicine. The authors pointed to mounting evidence that physician burnout takes a high toll on both physicians and the healthcare system.

Previous research had suggested that physicians may be susceptible to professional burnout, characterized by emotional exhaustion, depersonalization or cynicism and a low sense of personal accomplishment.

Tait D. Shanafelt, MD, from the department of internal medicine at Mayo Clinic in Rochester, Minn., and colleagues sought to evaluate burnout among U.S. physicians, explore differences by specialty and compare physicians with other workers.

The researchers sent a survey to 89,831 physicians in June 2011, using the Maslach burnout inventory (MBI) to measure burnout and also assess symptoms of depression and suicidal ideation and satisfaction with work-life balance. A total of 27,276 physicians responded. A population control sample was comprised of 5,930 U.S. adults.

“When assessed using the MBI, 37.9 percent of U.S. physicians had high emotional exhaustion, 29.4 percent had high depersonalization, and 12.4 percent had a low sense of personal accomplishment,” wrote Shanafelt and colleagues.

Symptoms were highest among physicians in emergency medicine, general internal medicine, neurology and family practice. Radiology ranked as the fifth highest risk for burnout after adjusting for age, sex, call schedule, relationship status, primary practice setting, hours worked per week and years since graduation from medical school.

The researchers reported physicians worked a median of 10 hours more per week than population controls, at 50 hours weekly for physicians. A total of 37.9 percent of physicians worked 60 hours or more per week.

Physicians faced a 32.1 percent risk for emotional exhaustion, 19.4 percent for depersonalization and 37.9 percent for overall burnout. All rates were higher than population controls.

“Collectively, the findings of this national study indicate that (1) the prevalence of burnout among U.S. physicians is at an alarming level, (2) physicians in specialties at the front line of care access (emergency medicine, general internal medicine, and family medicine) are at greatest risk, (3) physicians work longer hours and have greater struggles with work-life integration than other U.S. workers, and (4) after adjusting for hours worked per week, higher levels of education and professional degrees seem to reduce the risk for burnout in fields outside of medicine (MD or DO) increases the risk,” wrote Shanafelt et al.

The researchers detailed potential personal implications of burnout, including problematic alcohol use, broken relationships and suicide ideation. They also pointed out that the high rate of burnout suggests the problem is rooted in the configuration of the healthcare delivery system, rather than individuals.

“Policy makers and healthcare organizations must address the problem of physician burnout for the sake of physicians and their patients,” wrote Shanafelt et al.

The study was published Oct. 8, 2012, and sparked a recent response from the emergency medicine community. Check out Health Imaging on March 27 to learn more about the exceptionally high rate of burnout among emergency physicians and strategies for remedying the problem.