Greater awareness regarding physician burnout

Have you noticed the recent flurry of articles focusing on physician burnout? Earlier this year, the AMA launched their "STEPS Forward" program to address the issue of physician burnout.

AMA STEPS Forward is an interactive practice transformation series offering innovative strategies that will allow physicians and their staff to thrive in the evolving health care environment by working smarter, not harder. Physicians looking to refocus their practice can turn to AMA STEPS Forward for proven, physician-developed strategies for confronting common challenges in busy medical practices and devoting more time to caring for patients.

Earlier this month, an article published in Mayo Clinic Proceedings sparked interest in this topic and a series of publishers released articles on this topic. They also referenced the Dec 8, 2015 JAMA article titled, "Prevalence of Depression and Depressive Symptoms Among Resident Physicians: A Systematic Review and Meta-analysis." What starts in residency as extreme mental stress, poor coping skills, and psychological trauma often carries itself to the working world.

Last month on the TEDMED stage, Dr. Pamela Wible spoke about the difficult topic of physician suicide. Physicians may be reluctant to admit that they are thinking about suicide because they may lose their ability (and privilege) to practice medicine. They may jeopardize their careers.

What is the medical community doing to provide support and assistance to medical students, residents, and physicians who may be struggling at work? There is tremendous need to bridge some of these gaps by providing counselors, coaches, mentors, and others who can assess symptoms, identify "red flags," and offer practical suggestions and assistance so that these medical professionals do not continue to struggle alone.

The International Conference on Physician Health (ICPH) is a first step in the right direction, but the focus of this conference remains too narrow (in my opinion) and does not introduce students and physicians with other needed resources on how they can overcome burnout, explore career transitions, or pursue other types of jobs that may provide a healthier work/life balance.

Mayo Clinic Proceedings:
Changes in Burnout and Satisfaction With Work-Life Balance in Physicians and the General US Working Population Between 2011 and 2014

Burnout Among U.S. Medical Students, Residents, and Early Career Physicians

An article worth reading that came out earlier this month in Academic Medicine:

Burnout Among U.S. Medical Students, Residents, and Early Career Physicians Relative to the General U.S. Population

Dyrbye, Liselotte N. MD, MHPE; West, Colin P. MD, PhD; Satele, Daniel; Boone, Sonja MD; Tan, Litjen MS, PhD; Sloan, Jeff PhD; Shanafelt, Tait D. MD

Purpose: To compare the prevalence of burnout and other forms of distress across career stages and the experiences of trainees and early career (EC) physicians versus those of similarly aged college graduates pursuing other careers.

Method: In 2011 and 2012, the authors conducted a national survey of medical students, residents/fellows, and EC physicians (≤ 5 years in practice) and of a probability-based sample of the general U.S. population. All surveys assessed burnout, symptoms of depression and suicidal ideation, quality of life, and fatigue.

Results: Response rates were 35.2% (4,402/12,500) for medical students, 22.5% (1,701/7,560) for residents/fellows, and 26.7% (7,288/27,276) for EC physicians. In multivariate models that controlled for relationship status, sex, age, and career stage, being a resident/fellow was associated with increased odds of burnout and being a medical student with increased odds of depressive symptoms, whereas EC physicians had the lowest odds of high fatigue. Compared with the population control samples, medical students, residents/fellows, and EC physicians were more likely to be burned out (all P < .0001). Medical students and residents/fellows were more likely to exhibit symptoms of depression than the population control samples (both P < .0001) but not more likely to have experienced recent suicidal ideation.

Conclusions: Training appears to be the peak time for distress among physicians, but differences in the prevalence of burnout, depressive symptoms, and recent suicidal ideation are relatively small. At each stage, burnout is more prevalent among physicians than among their peers in the U.S. population.

Academic Medicine: March 2014 - Volume 89 - Issue 3 - p 443–451

Physician Lifestyles and Burnout

Experiencing burnout? You're not alone. You may be able to relate with the 2013 Medscape slideshow titled, "Physician Lifestyles -- Linking to Burnout: A Medscape Survey"

Another journal article looking at physician burnout

The theme of physician burnout seems to come up over and over these days. Every week, I receive a series of emails from doctors who want to leave clinical medicine because they're just burning out and they're very dissatisfied with the practice of medicine.

This recent Archives of Internal Medicine article is titled, "Burnout and Satisfaction With Work-Life Balance Among US Physicians Relative to the General US Population."

Here's the conclusion:

Burnout is more common among physicians than among other US workers. Physicians in specialties at the front line of care access seem to be at greatest risk.

What are you doing to avoid burnout?

Burnout and Satisfaction With Work-Life Balance Among US Physicians

Don't miss this Arch Intern Med article titled, "Burnout and Satisfaction With Work-Life Balance Among US Physicians Relative to the General US Population"

Were you one of the 7288 who completed the survey?

Here's the abstract:

Background Despite extensive data about physician burnout, to our knowledge, no national study has evaluated rates of burnout among US physicians, explored differences by specialty, or compared physicians with US workers in other fields.

Methods We conducted a national study of burnout in a large sample of US physicians from all specialty disciplines using the American Medical Association Physician Masterfile and surveyed a probability-based sample of the general US population for comparison. Burnout was measured using validated instruments. Satisfaction with work-life balance was explored.

Results Of 27 276 physicians who received an invitation to participate, 7288 (26.7%) completed surveys. When assessed using the Maslach Burnout Inventory, 45.8% of physicians reported at least 1 symptom of burnout. Substantial differences in burnout were observed by specialty, with the highest rates among physicians at the front line of care access (family medicine, general internal medicine, and emergency medicine). Compared with a probability-based sample of 3442 working US adults, physicians were more likely to have symptoms of burnout (37.9% vs 27.8%) and to be dissatisfied with work-life balance (40.2% vs 23.2%) (P < .001 for both). Highest level of education completed also related to burnout in a pooled multivariate analysis adjusted for age, sex, relationship status, and hours worked per week. Compared with high school graduates, individuals with an MD or DO degree were at increased risk for burnout (odds ratio [OR], 1.36; P < .001), whereas individuals with a bachelor's degree (OR, 0.80; P = .048), master's degree (OR, 0.71; P = .01), or professional or doctoral degree other than an MD or DO degree (OR, 0.64; P = .04) were at lower risk for burnout.

Conclusions Burnout is more common among physicians than among other US workers. Physicians in specialties at the front line of care access seem to be at greatest risk.

Authors:

Tait D. Shanafelt, MD; Sonja Boone, MD; Litjen Tan, PhD; Lotte N. Dyrbye, MD, MHPE; Wayne Sotile, MD; Daniel Satele, BS; Colin P. West, MD, PhD; Jeff Sloan, PhD; Michael R. Oreskovich, MD

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. Published online August 20, 2012. doi:10.1001/archinternmed.2012.3199.

Residents (and medical students) burning out from clinical medicine in the fall

July 1 marks the traditional start of internship/residency around the country. Many programs start in mid-June to help their interns get acclimated. It's only been a few weeks for some interns, but some are already burning out.

I'm always getting messages from interns, residents and medical students who are burning out from clinical medicine. They're not even thinking about all the issues tied to reimbursement. Rather, they are caught up with the heavy workload, the stress of patient care, and they're struggling to meet all the demands of various patients who often have social concerns and other complicating factors. This is particularly problematic in the fall when patient volume increases, when new interns are no longer technically "new," and when you're often entering and leaving work when it's dark outside.

Some of these residents and students burning out choose to quit or leave the world of clinical medicine. They make this decision without a solid exist strategy and then they find themselves asking many questions like, "what should I do with my career?"

QuantiaMD Launches Physician Wellbeing Initiative

Waltham, Mass. January 24, 2012 - QuantiaMD, the medical learning network, announces the launch of an initiative addressing physician wellbeing. The new Physician Wellbeing Special Interest Group (SIG) provides educational content, expert advice, tools and services aimed at lowering the prevalence of physician burnout and mitigating its negative impact on patient care. The comprehensive initiative focuses on physicians' physical, mental, financial and social health and can be accessed at http://www.quantiamd.com/home/sig_physician_wellbeing.

QuantiaMD reached out to its physician members and found that almost half want to prioritize their wellbeing, but currently do not. Other industry studies have highlighted the growing prevalence of physician burnout and stress and the positive correlation between physician health and patient care outcomes. Physician work satisfaction has been decreasing due to factors such as less time available to spend with patients, greater administrative burden and the increasing difficulty of staying up-to-date on medical thinking. With new healthcare regulations placing greater pressure and accountability on physicians, it is vital that they continue to maintain a healthy work-life balance in order to provide optimal patient care.

Physicians are experiencing burn out

According to this article on American Medical News, "Eighty-seven percent of 2,069 physicians surveyed said they feel moderately or severely stressed or burned out daily."

Physicians are seeking a less hectic schedule, a better work-life balance and greater compensation. Fourteen percent have left their jobs because of stress.

Respondents cited the top causes of stress as the struggling economy (51.6%), health system reform (46.4%) and Centers for Medicare & Medicaid Services policies (41.2%).

The research study was conducted by Physician Wellness Services and Cejka Search.

I know so many physicians who are burning out. They're running out of steam. They're drowning in stress and anxiety. They're looking for alternative employment opportunities. They're switching jobs.

Are you experiencing more stress than before? Are you considering a career change? Maybe you'll be reducing your clinical responsibilities and working part-time. If that's the choice you make, you can find plenty of other opportunities to fill the rest of your time.

Before you consider leaving clinical medicine for a non-clinical career, speak with several people about this important decision. Find other physicians who have made this type of transition. You may be risking long-term job security if you leave the bedside. You may also find yourself really missing the privilege of helping individual patients on a regular basis. It's very difficult (and in some cases, nearly impossible) to go back to clinical medicine once you've left it for several years.

The impact of physician stress is underestimated

On Healthcare Finance News, you'll find a short article titled, "Impact of physician stress is underestimated." The article is based on a report from Physician Wellness Services (PWS) and Cejka Search.

PWS’ and Cejka’s survey results are based on 2,069 completed surveys. Among the findings:

• 87 percent of respondents said they are moderately-to-severely stressed/burned out on an average day.
• 63 percent said they were more stressed or burned out than they were three years ago; 34.3 percent said they were much more stressed than they were three years ago.

The pace of delivering health care is only getting faster. There are increasing demands to deliver higher value while physician reimbursement declines in many cases. It's no wonder that burnout is becoming ubiquitous and that a growing number of physicians are looking for ways to escape from clinical medicine.

On LinkedIn, you'll find some physicians discussing the issue of burnout and physician help. Go to the American College of Physician Executives (ACPE) group on LinkedIn and you'll find a discussion titled, "How to get docs the help they need?"

Some physicians have poor coping mechanisms and they turn to substance abuse, alcohol, gambling, and other destructive behaviors. As a result, physician help programs in each state are kept busy managing and monitoring physicians who have exhibited addictive behaviors.

A recent article in Archives of Surgery titled, "Substance Abuse Among Surgeons: The Perils of Losing Your Credentials" reminds all of us that "Alcohol and drug abuse are a significant issue among physicians in general and surgeons in particular."

Quality of life, debt, and burnout among doctors-in-training (residency)

A recent JAMA article titled, "Quality of Life, Burnout, Educational Debt, and Medical Knowledge Among Internal Medicine Residents," concludes:

In this national study of internal medicine residents, suboptimal QOL and symptoms of burnout were common. Symptoms of burnout were associated with higher debt and were less frequent among international medical graduates. Low QOL, emotional exhaustion, and educational debt were associated with lower IM-ITE scores (Internal Medicine In-Training Examination (IM-ITE) scores).

Here's what the researchers found:

• Quality of life was rated “as bad as it can be” or “somewhat bad” by 2402 of 16 187 responding residents (14.8%). 
• Overall burnout and high levels of emotional exhaustion and depersonalization were reported by 8343 of 16 192 (51.5%), 7394 of 16 154 (45.8%), and 4541 of 15 737 (28.9%) responding residents, respectively.
• In multivariable models, burnout was less common among international medical graduates than among US medical graduates (45.1% vs 58.7%; odds ratio, 0.70 [99% CI, 0.63-0.77]; P < .001). Greater educational debt was associated with the presence of at least 1 symptom of burnout (61.5% vs 43.7%; odds ratio, 1.72 [99% CI, 1.49-1.99]; P < .001 for debt >$200 000 relative to no debt).
• Residents reporting QOL “as bad as it can be” and emotional exhaustion symptoms daily had mean IM-ITE scores 2.7 points (99% CI, 1.2-4.3; P < .001) and 4.2 points (99% CI, 2.5-5.9; P < .001) lower than those with QOL “as good as it can be” and no emotional exhaustion symptoms, respectively.
• Residents reporting debt greater than $200 000 had mean IM-ITE scores 5.0 points (99% CI, 4.4-5.6; P < .001) lower than those with no debt. These differences were similar in magnitude to the 4.1-point (99% CI, 3.9-4.3) and 2.6-point (99% CI, 2.4-2.8) mean differences associated with progressing from first to second and second to third years of training, respectively.

So, what does this suggest? For one thing, residency is grueling and many people burn out or feel that life is terrible. Does this change once physicians complete their residency and enter the busy working world of high-volume patients and stressful working conditions? For some, their outlook improves because their salary has significantly gone up. For others, they battle with greater stress and anxiety because they now have more responsibilities to shoulder as an attending. They no longer have that backup or safety net they used to have during residency training. 

Are you burning out?

Author: Heather Fork, MD, CPCC

Spit If You Think You Have Burnout! But let me duck first.

Your saliva may predict whether or not you might be at high risk for burnout, according to researchers in Montreal, as reported in Psychoneuroendocrinology.

By analyzing a sample of spit, abnormally low levels of the stress hormone cortisol can be detected – a red flag for impending burnout.

“Great!” You may be thinking. “A test to predict those at risk for burnout.  Use that for medical students; I’m already burned out.” 

I find that a lot of doctors feel burned out, but have not been given much, if any, information on burnout and what can be done.  Because burnout occurs in stages, and has a variety of symptoms and causes, there are no simple “one-size fits all” explanations or pat remedies. 

Professional Burnout Among Surgeons

Are you experiencing burnout? In the August 16, 2010 edition of the Arch Otolaryngol Head Neck Surg, we see this issue addressed among very specialized surgeons. Here's the full title of the study: "Professional Burnout Among Microvascular and Reconstructive Free-Flap Head and Neck Surgeons in the United States."

Objectives  To determine the prevalence of professional burnout among microvascular free-flap (MVFF) head and neck surgeons and to identify modifiable risk factors with the intent to reduce MVFF surgeon burnout.

Design  A cross-sectional, observational study.

Setting  A questionnaire mailed to MVFF surgeons in the United States.

Participants  A total of 60 MVFF surgeons.

Main Outcomes Measures  Professional burnout was quantified using the Maslach Burnout Inventory–Human Services Study questionnaire, which defines burnout as the triad of high emotional exhaustion (EE), high depersonalization (DP), and low personal accomplishment. Additional data included demographic information and subjective assessment of professional stressors, satisfaction, self-efficacy, and support systems using Likert score scales. Potential risk factors for burnout were determined via significant association (P < .05) by Fisher exact tests and analyses of variance.

Results  Of the 141 mailed surveys, 72 were returned, for a response rate of 51%, and 60 of the respondents were practicing MVFF surgeons. Two percent of the responding MVFF surgeons experienced high burnout (n = 1); 73%, moderate burnout (n = 44); and 25%, low burnout (n = 15). Compared with other otolaryngology academic faculty and department chairs, MVFF surgeons had similar or lower levels of burnout. On average, MVFF surgeons had low to moderate EE and DP scores. High EE was associated with excess workload, inadequate administration time, work invading family life, inability to care for personal health, poor perception of control over professional life, and frequency of irritable behavior toward loved ones (P < .001). On average, MVFF surgeons experienced high personal accomplishment.

Conclusions  Most MVFF surgeons experience moderate professional burnout secondary to moderate EE and DP. This may be a problem of proper balance between professional obligations and personal life goals. Most MVFF surgeons, nonetheless, experience a high level of personal accomplishment in their profession.

Study by Stephanie P. Contag, BA; Justin S. Golub, MD; Theodoros N. Teknos, MD; Brian Nussenbaum, MD; Brendan C. Stack Jr, MD; David J. Arnold, MD; Michael M. Johns III, MD

Click here for more information.

Physician burnout: what's the solution?

There have been a number of articles over the years evaluating physician burnout. Due to changes in reimbursement over the past few decades, physicians are often seeing more patients each day. They're spending less time with each patient and they're burning out because of the increased workload, the paperwork, and the stress associated with the practice of clinical medicine. So, what's the solution?

We know that some physicians are leaving clinical practice to pursue other careers. Others are looking for less strenuous work models such as cash or concierge practices. Is this the right solution? Are these physicians finding better work/life balance after making these types of transitions?

I think the solution needs to start in the medical schools. Students need to be educated about the importance of work/life balance and they also need to learn how to creatively develop practice models that will allow them to reach an appropriate balance. Our health care system also needs to be changed so that physicians are being adequately reimbursed for their services.

For those who do choose to leave clinical medicine, they need to know how to find the right opportunities. If you're a surgeon and you want to pursue a non-clinical career, do you know what you could do with your education and training? What if you're a radiologist or a pathologist? If you're considering a career transition, you may want to work with a career coach who can guide you through that process. Click here to learn about the career coaching services we offer on NonClinicalJobs.com.

Burnout and Suicidal Ideation among Medical Students

A recent article in the Annals of Internal Medicine focuses on the question of burnout and suicidal ideation among United States medical students. How prevalent is suicidal ideation among medical students? We all know that students, residents, and attendings experience burnout. So these authors looked at 7 different medical schools from 2006 to 2007 and found that:

• Burnout was reported by 49.6% (95% CI, 47.5% to 51.8%) of students, and 11.2% (CI, 9.9% to 12.6%) reported suicidal ideation within the past year. 
• Recovery from burnout was associated with markedly less suicidal ideation, which suggests that recovery from burnout decreased suicide risk. 

What does this tell us about our existing medical school system? What can we do to ensure that students, residents, and physicians who are experiencing burnout are getting the proper help they need? You can access the abstract here.