Physician Burnout
BACKGROUND
While employees in many professions report burnout, physicians appear uniquely susceptible and the consequences can be detrimental. Physicians are fifteen times more likely to suffer burnout than other professions and statistics indicate that at a given time nearly a third of physicians are experiencing symptoms of burnout.[1] Throughout the course of a career nearly one in two physicians are likely to suffer from burnout, and depending on specialty, it can range from 30 to 65% of physicians. Physicians in the mid-point of their career are the most likely sufferers, but the rates and trends across age groups continue to worsen.[2] Indicated in a Mayo Clinic study, about 50% of physicians will experience symptoms of burnout at some point in his or her career.[3]
CAUSES & IMPACT
Various theories are offered as to why the problem is reaching epidemic proportions for physicians. One commonly identified contributing factor is that physicians feel increasingly overworked. One study identified the lack of control over a physician’s daily schedule as a primary driver for experiencing burnout.[4] Technology is also recognized as a culprit and studies show doctors are increasingly spending time on the computer instead of interacting with patients.[5] Yet another modern contributor to physician stress can be negative online reviews.[6] Physicians may be feeling increasingly judged and scrutinized by the patients they are dedicated to helping. Outside technology, a decrease in healthy eating habits or exercise is also shown to lead to or exacerbate the problem.[7] This decrease in quality of life is likely driving physicians from the practice of medicine, which further increases stress on the health care system already facing a looming physician shortage as baby boomers retire.[8]
The impact of physician burnout can be enormous. On an individual level, it is destroying quality of life for physicians to the point that many leave the practice of medicine or even turn to suicide. Rates for physician suicide are double that of other professions, with female physicians three times as likely.[9] Increased suicide rates are not only high throughout a physician’s career, but are also evident in medical students with 9.4% of students reporting suicidal thoughts.[10] Physician burnout has also been associated with significant decreases in patient care and safety.[11]
SOLUTIONS
While there are no simple or obvious solutions to physician burnout, there are multiple approaches to consider. For starters, physicians and the greater medical community cannot afford to ignore the impact burnout is having on both individual physicians and the practice of medicine. The impact of burnout continues to worsen and may be approaching epidemic proportions. One component physicians should recognize is that shouldering the burden themselves is not enough; to paraphrase a classic literary character, you can’t just work harder.[12] Physicians may need to change the way they practice medicine; by recognizing limitations and learning to say “no.”
Other studies point to promoting lifestyle decisions as a way to combat burnout. Specifically, physicians should find ways to maintain a healthy lifestyle. This can involve eating a healthy diet, sleeping 7-9 hours regularly, and exercising appropriate amounts.[13] Besides physical health, physicians should be encouraged to have creative outlets such as hobbies, sports, leisure activities, and vacations.
PROASSURANCE’S EFFORTS
ProAssurance is also seeking ways to support physicians and the medical community regarding burnout and the implications it may have on patient care. In September 2017, ProAssurance established a $1.5 million gift to the University of Alabama at Birmingham (UAB) School of Medicine to endow a chair to support physician wellness. This endowment was to support research and efforts addressing the issues and challenges related to physician burnout. UAB combined the endowed chair with the existing Chief Wellness Officer position, which was filled by David Rogers, MD, MHPE in January 2018.
In a recent interview with Dr. Rogers, he stated, “Many people talk about burnout as though you’re burned out or you’re not. But it isn’t that simple. There are degrees of burnout or being engaged. Month by month tracking lets you see a pattern and reevaluate before things spiral in a negative way.”
The use of month to month well-being assessments such as the Mayo Clinic Well-Being Index[14] may help identify and track individual physicians’ well-being. Hospitals may utilize this assessment to identify certain departments where stress and/or engagement are particularly high. These results could customize resilience training for these groups.
Accomplishing goals to reduce burnout in the medical community means that there must be a systemic and cultural shift. Physicians need to be free from judgment in seeking solutions to this crisis. From his experience, Dr. Rogers would also like to focus on training for frontline leaders in the medical industry. Leaders often set the tone for their employees, so teaching them to identify and mitigate stress is essential. Dr. Rogers believes the medical community is at a crucial point and must start having conversations about physician burnout. “There has to be a change in culture,” he concludes. “It’s hard, but critical to think about what happened to the industry, what we can do to correct it, and what lessons we can learn for the future.”
As professional liability insurers, ProAssurance recognizes the increasing danger of physician burnout and the potential harm to our insured physicians and organizations. Although we have identified the increasing seriousness of this problem, but still struggle with how to identify or prevent it. We are committed to finding ways to discover the problem before it manifests in professional liability claims, and we encourage our physicians to reach out for solutions if they are feeling overwhelmed or at risk for burnout.
Physicians insured by ProAssurance may contact our Risk Resource department for prompt answers to liability questions by calling 844.223.9648 or via e-mail at RiskAdvisor@ProAssurance.com.
[1] Dr. Elaine Cox, M.D., “Doctor Burnout, Stress and Depression: Not an Easy Fix,” April 12, 2016, https://health.usnews.com/health-news/patient-advice/articles/2016-04-12/doctor-burnout-stress-and-depression-not-an-easy-fix accessed September 29, 2017.
[2] Staff, “Medical specialties with the highest burnout rates,” AMA Wire, Jan 15, 2016. https://wire.ama-assn.org/life-career/medical-specialties-highest-burnout-rates accessed September 29, 2017.
[3] Tait D. Shanafelt, M.D. et al, “Changes in Burnout and Satisfaction With Work-Life Balance in Physicians and the General US Working Population Between 2011 and 2014,” Mayo Clinic Proceedings , Volume 90 , Issue 12 , 1600 – 1613 http://www.mayoclinicproceedings.org/article/S0025-6196(15)00716-8/abstract accessed September 29, 2017.
[4] Dr. Elaine Cox, M.D., “Doctor Burnout, Stress and Depression: Not an Easy Fix,” April 12, 2016, https://health.usnews.com/health-news/patient-advice/articles/2016-04-12/doctor-burnout-stress-and-depression-not-an-easy-fix accessed September 29, 2017.
[5] Paige Minemyer, “Study: Docs spend more time with computers than patients,” Jan 31, 2017, http://www.fiercehealthcare.com/it/study-docs-spend-more-time-computers-than-patients accessed September 29, 2017.
[6] http://www.upi.com/Health_News/2017/02/02/New-study-shows-online-reviews-stressful-for-doctors/9561486052157/
[7] Dr. Elaine Cox, M.D., “Doctor Burnout, Stress and Depression: Not an Easy Fix,” April 12, 2016, https://health.usnews.com/health-news/patient-advice/articles/2016-04-12/doctor-burnout-stress-and-depression-not-an-easy-fix accessed September 29, 2017.
[8] “Physician Supply and Demand Through 2025: Key Findings,” AAMC https://www.aamc.org/download/426260/data/physiciansupplyanddemandthrough2025keyfindings.pdf
Accessed September 29, 2017.
[9] Pranay Sinha, “Why Do Doctors Commit Suicide?,” New York Times, Sept 4, 2014, https://www.nytimes.com/2014/09/05/opinion/why-do-doctors-commit-suicide.html Accessed September 29, 2017.
[10] Louise B Andrew, MD, JD, “Physician Suicide,” Medscape, June 12, 2017. https://emedicine.medscape.com/article/806779-overview accessed September 29, 2017.
[11] Megan Brooks, “Provider Burnout Tied to Lower Levels of Patient Safety, Care,” MedScape, http://www.medscape.com/viewarticle/873434 accessed September 29, 2017.
[12] https://en.wikipedia.org/wiki/Boxer_(Animal_Farm)
[13] Dr. Elaine Cox, M.D., “Doctor Burnout, Stress and Depression: Not an Easy Fix,” April 12, 2016, https://health.usnews.com/health-news/patient-advice/articles/2016-04-12/doctor-burnout-stress-and-depression-not-an-easy-fix accessed September 29, 2017.
[14] https://www.mayo.edu/research/centers-programs/program-physician-well-being/mayos-approach-physician-well-being/mayo-clinic-well-being-index Accessed December 20, 2018.
