By Doug Brunk, San Diego Bureau
Dr. Darrell A. Campbell Jr. followed in his father's footsteps and became a surgeon. But the young Dr. Campbell is careful not to follow in his father's footsteps in one way: He's not letting his work consume him to the point of burnout.
“I saw it firsthand when I was growing up,” recalled Dr. Campbell, assistant dean and chief of clinical affairs at the University of Michigan Health System, Ann Arbor. For my father, “there was a progressive loss of interest in the profession and a turning away from it, not being as excited about the practice of medicine as he had been before. I know it was because he was in solo private practice for many years. Cumulative stress had that influence on him.”
Physician burnout interests Dr. Campbell so much that he led a study to assess its prevalence among 582 American surgeons (Surgery 2001;130:696–705).
The results of his study indicated that 32% of surgeons showed high levels of emotional exhaustion, 13% showed high levels of depersonalization, and 4% showed evidence of perceived lack of personal accomplishment, which are three hallmark components of burnout, he said.
Physicians who experience burnout have “a progressive loss of interest in what they're doing and feel that they don't have anything left to give their patients,” Dr. Campbell said.
“It's important to make the distinction between burnout and depression. Burnout is more of a reference to your work setting, whereas depression is a more global type of phenomenon, which would extend to every aspect of your life,” he added.
Surgeons aren't the only physicians who are at risk for developing burnout, Dr. Campbell noted.
In a yet-to-be published study that included 1,800 members of the Michigan State Medical Society, Dr. Campbell and his associates found that about 30% of surgeons suffered from high levels of emotional exhaustion, while the prevalence was even higher—nearly 60%—for radiologists and physicians in family medicine.
The investigators also found that physicians who practice in communities of less than 50,000 people were more likely to report feeling burned out, compared with their counterparts who practice in communities with a population of 100,000 or more.
“I think it's because of the stresses of practicing alone or in small places where there's not a lot of networking [or the] ability to talk about problems” with other physicians, and getting their help with on-call coverage, Dr. Campbell explained.
The consequences of all this are troubling, he added, because burned-out physicians are more likely to retire early and not join professional medical societies. “They don't become as involved in the future of the profession, which is a bad thing,” he said. “And I think there are questions about their performance. Some data [suggest] that burnout can affect your performance as a physician.”
Several factors in what Dr. Eugene V. Boisaubin called “the hassle factor” of modern medical practice may contribute to burnout.
“That is, the idea that a lot of the enjoyment has been taken out of it; the regulations have become overwhelming; [and] the pressures from patients, third-party payers, and liability issues have mounted to the point that physicians feel they are not enjoying their professional role as being doctors and what they're doing is not what they went into medicine for,” said Dr. Boisaubin, an internist who is a professor of medicine at the University of Texas Health Science Center at Houston.
The current state of medicine isn't the only trigger. Many people in today's society are “overbooked,” including children, noted Dr. Rebecca E. Moskwinski, a family physician who works in the student health center at the University of Notre Dame, Indiana.
“We seem [to not be able] to really relax and 'do nothing' with the pace of modern life,” said Dr. Moskwinski, who has six children aged 14–22. “Physicians especially are often 'givers' and don't know when to say no or to take a vacation.”
Another potential trigger is being in a certain type of practice for the wrong reasons, including “money, prestige, [it's] what your dad did, [or] whatever,” she said. “These people seem to burn out quicker than others. I have seen many completely change their type of practice (for instance, leave a busy private practice to do ER work) and they seem much happier for it.”
She and other physicians interviewed offered the following tips on how to avoid burnout:
▸ Strive for balance. In Dr. Campbell's most recent study of Michigan physicians, those who described themselves as emotionally exhausted believed they were “out of balance” with respect to work, family, and their own personal growth and development. On the other hand, “physicians who are engaged, which is the opposite of burnout, said they tended to have good balance in those areas,” Dr. Campbell noted. “What that balance is differs for every person, but the question is, are you comfortable with it? Do you feel good?”