American medicine is nearing a tipping point with physicians that could adversely affect broader populations of both patients and healthcare workers. More than half of U.S. physicians are experiencing professional burnout and the problem is getting worse, researchers report.1
Burnout reflects a life-job imbalance that manifests as emotional exhaustion, “loss of meaning” in work, and feelings of ineffectiveness, explains lead author Tait Shanafelt, MD, a leukemia clinician with a research interest in physician well-being at the Mayo Clinic in Rochester, MN. “We found that more physicians in almost every specialty are feeling this way. [This is] concerning, given the strongly established links between physician burnout and quality of care and medical errors.”
Physicians experiencing burnout may understandably decrease their work hours, which could compound a projected doctor shortage over the next decade. The recently published study2 follows a similar one in 2011, as the burnout trend is being followed in three-year increments. The current study found that 54% of U.S. physicians are now experiencing at least one symptom of burnout, up from 45% in 2011.
“The highest risk specialties continue to include emergency medicine, family medicine, and general internal medicine,” Shanafelt says. “But large increases have been observed for orthopedic surgeons, radiologists, and rehabilitation physicians. These groups are also now in the highest risk category.”
In contrast, burnout measures in the general workforce were stable over the period, suggesting that doctors are flaming out faster than other professions. Though the data are not as empirical, a poll taken at a nursing meeting last year found similar burnout rates among nurses. At the American Association of Critical-Care Nurses (AACN) meeting in San Diego last May, 60% of some 500 attendees said they had “moderate to severe” burnout due to such issues as increasing work complexity, conflict with colleagues, time and outcome demands, and expectations from patients and families, as well as ethical challenges. The AACN has developed a healthy workplace barometer of sorts that can help employee health professionals assess the mental health of staff and their work culture. (See related story in this issue.)
The physician study netted 6,880 (19.2%) responses to a nationally distributed survey. The researchers used the Maslach Burnout Inventory (MBI), finding that satisfaction with work-life balance also declined in physicians between 8% from 2011 and 2014. The MBI assesses measures of emotional exhaustion, depersonalization from patients and colleagues, and sense of personal accomplishment and competence at work.
The MBI scores revealed that 47% of physicians had high emotional exhaustion; 35% high depersonalization; and 16% reported a low sense of personal accomplishment in 2014. Suicidal ideation was an identical 6.4%, but that still means 438 respondents had thoughts of killing themselves within the last year in the 2015 study and 466 in the prior report. In that regard, an accompanying editorial3 to the 2015 study said the findings underscore the deteriorating mental health of a profession with a high rate of physician suicide (which is in part driven by a very high “success” rate because clinicians know precisely how to end life). The public and patients are becoming more aware of the issue, as the editorial cited a recent Time magazine article4 that “addresses many troubling facts about the state of physicians in the United States, including that as many as 400 U.S. physicians are dying by suicide each year, a number comparable, the author points out, with the graduating classes of two or three medical school classes annually.”">
In light of the findings, the researchers recommend that health organizations should focus on improving support in the practice environment and developing leaders with the skills to foster the following:
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physician engagement;
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help physicians optimize “career fit;”
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create an environment that nurtures community, flexibility, and control, all of which help cultivate meaning in work.
Organizational approaches to help physicians self-calibrate and promote their own wellness may also be beneficial.
There are also a number of steps physicians can take at the individual level to promote their own wellness, the authors noted. This often begins by identifying personal and professional values and determining how they will be prioritized when conflicts between personal and professional responsibilities arise. This exercise requires self-awareness, limit setting, and reframing, they noted.
Training in mindfulness-based stress reduction, which involves self-awareness, a focus on the present, and intentionality in thoughts and actions, has also been shown to be an effective approach to reduce physician stress and burnout. Scientific studies have also identified the habits and qualities that promote resilience in challenging situations, which are skills that can be learned and developed. Attention to self-care, developing personal interests, and protecting and nurturing relationships are also essential, the authors noted.
More than 75% of the physicians are now employed by large healthcare organizations and meaningful progress will require an effective response at both the individual level and the organization or system level. A related study5 published by the same lead author last year found that physicians have lost some level of autonomy and are more vulnerable to the effects of the department-level leaders that hold them accountable in the new paradigm. In this sense, physician burnout factors may parallel those of their nurse colleagues, who have long cited problems with lack of empowerment at the workplace.
“On a simple level, leadership matters,” Shanafelt says.
The leadership study, which drew responses from 2,813 physicians, found that “leadership dimensions” strongly correlated with the burnout and satisfaction scores. The findings have important implications for the selection and training of physician leaders and provide new insights into organizational factors that affect physician well-being.
“The effective leaders kept their physicians informed, they helped individuals develop professionally, they provided objective feedback, and perhaps most importantly, they asked physicians for their ideas and suggestions on how to solve the problems in the local work unit,” he says. “Then they empowered the physicians to actually implement those solutions.”
REFERENCES
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Shanafelt TD, Hasan O, Dyrbye LN. Changes in Burnout and Satisfaction With Work-Life Balance in Physicians and the General US Working Population Between 2011 and 2014. Mayo Clin Proceed 2015; 90:1600–1613.
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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.
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Ariely D, Lanier WL. Disturbing Trends in Physician Burnout and Satisfaction With Work-Life Balance. Dealing With Malady Among the Nation’s Healers. Mayo Clin Proc 2015 Dec;90(12):1593-1596.
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Oaklander, M. Life/Support: Inside the movement to save the mental health of America’s doctors. Time 2015;186:42–51.
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Shanafelt TD, Gorringe G, Menaker R, et al. Impact of Organizational Leadership on Physician Burnout and Satisfaction. Mayo Clin Proc 2015 Apr;90(4):432-440.
