Physicians are all too familiar with the phrase "burnout." Long hours, challenging employment, administrative obligations, and inefficient medical systems all contribute to clinicians' physical, mental, and emotional tiredness. Recent reports of physician burnout are so concerning that the American Medical Association (AMA) has declared it a separate health epidemic.
The Term: Physician Burnout
Burnout is defined by the American Psychological Association (APA) as "physical, emotional, or mental exhaustion accompanied by decreased motivation, lower performance, and negative attitudes towards oneself and others." Burnout is widespread in service-oriented professions that involve long hours and substantial physical and mental stress. In fact, according to an APA poll performed in 2021, 79% of adult workers experienced work-related stress, with nearly 60% reporting that it negatively impacted their life.
Although physician burnout has always been a looming issue in the background, new data suggest that its prevalence has nearly doubled in recent years. It appears to be a ticking time bomb, with many providers threatening to reduce their hours or exit the field entirely. A physician shortage in an already understaffed country might be fatal if adjustments are not implemented quickly.
Physician Burnout Rates
Many doctors believe they are alone or should not be dealing with the long-term stress and emotional consequences of working with patients. Physician burnout, on the other hand, has been a source of concern for decades. According to a 2012 JAMA Internal Medicine study, 45.8% of physicians had at least one burnout symptom.
Now, additional data reveal a startling rise in burnout, leaving many in the health-care industry wondering when the other shoe will drop. Shanafelt and colleagues' 2022 study, published in Mayo Clinic Proceedings, focused on data from the authors' survey of 2440 US physicians. Overall, 62.8% of responding physicians reported at least one burnout symptom, a significant rise over previous years. The authors of the study also discovered a 25% increase in burnout from the end of 2020 to the end of 2021.
Causes of Physician burnout
Physicians work in a physically, psychologically, and emotionally demanding environment. They must serve sick, terrified, or dying patients on a regular basis, including meetings with their family and/or carers and apparently endless bureaucratic chores, all on an uncontrollable timetable. The unrelenting nature of this work wears on many caring and sympathetic physicians over time.
Physician burnout is unlikely to be caused by a single component; rather, it appears to be the result of a combination of work-related pressures, increased performance pressure, long work hours, and a plethora of other demands. The following are a few of the many variables that are causing this occurrence.
1. Administrative Burdens and Incorporation of Electronic Health Records
The American Medical Association recognizes that administrative burdens and bureaucratic duties such as documentation, ordering laboratory testing and medication, and dealing with insurance companies are major causes of physician burnout. "While burnout manifests in individuals, it originates in systems," says Christine Sinsky, MD, AMA Vice President of Professional Satisfaction. Burnout is not caused by a lack of resilience in physicians; rather, it is caused by the institutions in which physicians work.
While the Office of the National Coordinator for Health Information Technology claims that EHRs can help increase physician productivity and work-life balance, this dream has yet to come true. Many clinicians report that EHRs exacerbate their burnout symptoms. According to the authors of a study published in the New England Journal of Medicine, for every hour spent with patients, physicians spend an extra 1 to 2 hours documenting their visits, prescribing drugs, and ordering more testing. Another poll of 585 primary care physicians found that 37% of them suffered burnout; three-quarters of those physicians blamed their symptoms on EHR work.
2. Lack of Work-Life Balance
The phrase "work-life balance" is frequently used as a goal to strive for these days. In an ideal world, everyone would be able to strike the perfect balance between job, family, friends, and interests; but, for physicians, this is rarely the case. In fact, Dr. Drummond observes that medical residents are frequently taught the inverse during their training.Out of fear of weakness, 11 generations of people have carried down the practice of disregarding emotional and spiritual needs.
Although the typical work week in the United States is 40 hours, most physicians work 40 to 60 hours each week. Even more surprising, roughly a quarter of physicians report working between 61 and 80 hours per week.
3. High Expectations and the Medical Education System
Physicians are held to exceedingly high standards throughout their education and training from the start. Dike Drummond, MD, wrote an essay in Family Practice Management about the five main causes of physician burnout, one of which being the impact of medical education. While in school and residency, physicians frequently push themselves to outperform and become "workaholics" and perfectionists.
"The same characteristics that contribute to our success as physicians also contribute to burnout," writes Dr. Drummond. In the medical field, there is also a cultural stigma associated with mental health. Physicians are less likely to seek mental health therapies and support because they are afraid of losing their medical license. They also struggle to find easily accessible services that provide care during their hectic workplace.
4. Time and Pressure
Depending on the profession, doctors may see dozens of patients per day. The need to check and treat as many patients as possible looms large. According to the findings of the Agency for Healthcare Research and Quality's Minimizing Error, Maximizing Outcome (MEMO) research, more than half of physicians reported feeling stressed due to time constraints.
The study found that more than half of physicians are under pressure to conduct physical tests rapidly. Many additionally claim that they require more time than their appointments allow in order to give adequate patient care. Working against the clock all the time contributes to physician burnout, especially if the objective of seeing so many patients every day is impossible.
Physician burnout Symptoms
According to Dr. Drummond, burned-out physicians frequently enter "survival mode," in which they simply try to get through the day so they can get home. Physicians gradually lose motivation, enthusiasm in their work, and investment in their patients.
Christina Malasch, PhD, and colleagues discovered the three key indications of burnout in the 1970s: weariness, diminished personal achievement, and depersonalization.Other generalized burnout symptoms include:
- Feelings of anxiety, rage, frustration, or fear
- Inability to feel contentment, happiness, or joy, particularly in relation to their career
- Headaches, stomach issues, difficulty sleeping, and muscle tension are some of the physical symptoms.
Side-Effects of Physician Burnout
Physician burnout has an impact not just on physicians but also on the scope and quality of care provided to patients. Providers who are exhausted or burned out are more likely to make medical mistakes and struggle to connect with patients. According to a 2014 poll, 10.5% of physicians have made at least one severe medical error in the previous six months. 77% of them have experienced burnout symptoms. Burnout is also linked to an increase in malpractice claims and, in general, erodes trust and relationships between physicians and patients.
The combination of patient unhappiness, performance pressure, and a shattered support structure has the potential to drive physicians away from their chosen sector. Patients will have less access to care as there are fewer physicians in practice. Even if burned-out doctors stay in their jobs, they are more likely to reduce their efforts, routinely perform subpar work, and take more sick days.
Reducing Physician Burnout
So, what can be done to alleviate physician burnout? Medical organizations, such as the American Medical Association and the American College of Physicians, are actively striving to drive change in the medical industry by providing resources and training programs on burnout.
The most essential thing physicians can do is take preventative measures to avoid burnout before it occurs. Mamta Gautam, MD, wrote in the AMA Journal of Ethics that physicians should focus on what they can manage, take regular breaks and holidays, and recognize that "good enough" is sometimes enough. Set realistic goals for yourself."