Commentary

Does Burnout Threaten the U.S. Health System?


 

Physicians seem to have a much higher level of burnout than do other professionals with equivalent training and those on the front lines of care are at the highest risk, according to a first-of-its-kind study.

But does it, as the authors say, threaten the underpinnings of American medicine?

"When considered with the mounting evidence that physician burnout adversely affects quality of care, these findings suggest a highly prevalent and systemic problem threatening the foundation of the U.S. medical care system," the authors wrote in a study published online Aug. 20 in Archives of Internal Medicine.

(c)Maridav/iStockphoto.com

They conclude that doctors work longer hours – a median of 53 per week compared with 42 for the general population – and struggle harder to balance work and life than do other workers. Level of professional education – which seems to reduce the risk of burnout in other fields – only increases the risk in medicine, according to the authors.

Plenty of studies have documented burnout, alcohol and substance abuse, and suicidal ideation in various medical specialties, but none have directly compared specialties, the researchers said.

Overall, about 38% of physicians reported being burned out, compared with 28% of the general population. A little more than a third of doctors said that work did not leave them enough time for personal or family life.

Burnout was highest among emergency physicians – more than 60% reported burnout – followed closely by general internists, neurologists, and family physicians. Least burned out? Preventive and occupational medicine specialists, pathologists, pediatricians, and dermatologists. Even so, a third or more of those doctors said they were burned out.

For work-life balance, dermatologists and pediatricians, along with radiologists, were the most satisfied, with close to 60% reporting they strongly agreed or agreed that their work schedule left them enough time for a personal or family life. Surgeons were the least balanced, followed by ob.gyns. and neurologists.

Some 7,288 physicians responded to the survey. Forty percent were at least 30 years out of medical school; the 55- to 64-year-olds represented the biggest cohort, comprising 36% of the participants. Fifty-six percent were in a private practice and 20% were academicians. The remainder were either military doctors, retirees, or did not report a practice setting. The study also used a random sample control group of workers aged 29-65 years for comparison.

Burnout was gauged with the Maslach Burnout Inventory. Potential depression was assessed via the 2-item Primary Care Evaluation of Mental Disorders; respondents also were asked about suicidal ideation in the last year.

The study was funded by the American Medical Association and the Mayo Clinic Department of Medicine Program on Physician Well-Being. The authors reported no conflicts.

Though the authors call on policy makers and stakeholders in the health care realm to address burnout, they acknowledge that there’s no proven formula for making it all better.

–Alicia Ault (on Twitter @aliciaault)

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