courtesy Martin Barraud
Professional burnout among U.S. physicians has reached a dangerous level, with more than half of physicians affected, according to the results of a 2014 national survey across various medical specialties and practice settings.
Compared with responses from a similar survey in 2011, burnout and satisfaction with work-life balance have become progressively worse, even as measured over that relatively brief interval. And the repercussions for Americans seeking effective health care are potentially vast.
Tait D. Shanafelt, MD, Department of Internal Medicine, Mayo Clinic and colleagues from Mayo and from the AMA surveyed both U.S. physicians and a probability-based sample of the general U.S. population using previously-validated methods and measures over the 6-week interval from August 28 to October 6, 2014.
Burnout was measured using validated metrics, and satisfaction with work-life balance was assessed using standard tools, and compared (along with general work-life balance satisfaction) to prior studies from 2011.
The results of their survey were quite disturbing, as published in the latest Mayo Clinic Proceedings, entitled "Changes in Burnout and Satisfaction With Work-Life Balance in Physicians and the General U.S. Working Population Between 2011 and 2014."
Almost 7,000 physicians (out of more than 35,000 invited, response rate 19 percent) completed the survey between August and October 2014. Among those responding, two-thirds were male, and the overall mean age was 56 years.
Dr Shanafelt and colleagues compared the results with those from the 2011 survey and with those for a probability-based sample of working adults in the general population surveyed during the same period. Burnout rates (evaluated with the Maslach Burnout Inventory), depressive symptoms, suicidal ideation in the last 12 months, and satisfaction with work life balance were among the measured characteristics.
A shade under 55 percent of responding physicians reported at least one symptom of burnout in 2014, compared with 45.5 percent in 2011, a highly significant difference. Satisfaction with work-life balance also declined during the three years, to 41 percent vs 48.5 percent in 2011.
Women physicians had a 29 percent higher burnout risk than their male colleagues, for unknown reasons. On the measure of work-life balance, satisfaction declined in 2014 for all specialty disciplines except obstetrics/gynecology and general surgery. Only minimal differences were noted between 2011 and 2014 in respondents reporting symptoms of depression (40 percent vs 38 percent), and there was no difference in the rates of suicidal ideation, which held at 6.4 percent for both years.
In contrast, working adults in the general population experienced only minimal changes in burnout or work-life balance satisfaction between 2014 and 2011 (about 28 percent). After multivariate adjustment for age, sex, marital/partnership status, and workweek, physicians faced an almost two-fold greater risk for burnout compared with nonphysician working adults.
"American medicine is at a tipping point," Dr. Shanafelt, MD told Medscape Medical News. "If a research study identified a system-based problem that potentially decreased patient safety for 50% of medical encounters, we would swiftly move to address the problem. That is precisely the circumstance we are in, and we need an appropriate system-level response."
An editorial in the same issue entitled "Dealing With Malady Among the Nation's Healers" by Dan Arielly, PhD, Duke University Professor of Psychology, and William L. Lanier, MD, Editor in Chief of the journal, had this disheartening commentary:
"Recent data analyses reveal the disturbing decline in well-being of contemporary U.S. physicians. ... [T]he September 7, 2015, issue of TIME Magazine featured an article titled 'Life/Support: Inside the Movement to Save the Mental Health of America s Doctors.' The article addresses many troubling facts about the state of physicians in the United States, including that as many as 400 US 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. Physicians who remain in practice while burned out show higher propensities for making medical errors and diminished quality of medical practice and professionalism. Worse still, patients of depleted physicians are less compliant with physicians care plans. These disquieting patterns, the author concludes, show that '[d]octors are stressed, burned out, depressed, and when they suffer, so do their patients.'"
So it is agreed that there's a deadly serious problem eating at the heart of America's medical system. Now, how do we figure out how to deal with it successfully? No one had an answer.