Burnout among practicing physicians
The physician burnout crisis should have been readily predictable. An aging population with growing comorbidities is being cared for by a system with too few physicians, leading to increasing workloads. Compounding the problem are unrelenting compliance and regulatory burdens and ill-advised and premature introduction of decidedly user-unfriendly electronic health records (EHRs). The latter have not been shown to reduce costs or improve quality but unarguably consume an enormous amount of time during the day and are increasingly being accessed at night when many physicians try to catch up on their charting.
Adding to this confluence of pain are generational factors. Generation-X and millennial students and residents, raised in the 80-hour-work-week environment, appear particularly vulnerable to burnout as they enter their early and mid-careers, while older physicians exposed to far harsher training regimens appear more resistant to burnout. A final element of this witches’ brew is the current chaotic nature of the American healthcare delivery system in which the Center for Medicare & Medicaid Services (CMS) reconsiders its commitment to the highly complex Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) and hospital value-based payments schemes. Many physicians and hospitals have invested considerable time and dollars preparing for these changes. Similarly, Congress is attempting to kill the Affordable Care Act by a thousand cuts rather than a simple coherent repeal and replace strategy. All this chaos creates uncertainty and frustration among physicians, elements that promote burnout.
A recent survey conducted jointly by the American Medical Association and the Mayo clinic reported that burnout is increasing among virtually all medical specialties with a more than 10% increase in just 3 years.4 For example, 51% of family medicine physicians reported burnout in 2011 compared with 63% in 2014. Similar trends were observed among general pediatrics, urology, orthopedic surgery, physical medicine and rehabilitation, pathology, radiology and general surgery.
In a 2018 survey of over 15,000 ob/gyns across various subspecialties, 50% felt burned out, depressed, or both.5 Even more concerning, a far higher percentage of female ob/gyns reported burnout (55%) compared to men (32%). As expected, bureaucratic burdens, often related to EHRs, and long hours were cited as the two biggest contributors. When asked if resources were available to help them cope, a mere 27% said such offerings were at their disposal. Another recent Medscape survey of 15,543 physicians practicing in the United States across 29 medical specialties demonstrated that ob/gyns had the fourth highest rates of burnout (46%) and led all other fields in those experiencing both burnout and depression (20%).6 Respondents listed exercise, talking with family and close friends and sleep as their top three coping mechanisms. They also opined that increased compensation, more manageable workloads and decreased government regulations would reduce burnout.
Beyond the personal pain engendered by burnout and associated substance abuse and depression, burnout is also an independent predictor of medical errors, malpractice suits, hospital-acquired infections and patient mortality.7-10 Burnout also increases provider turnover which adds costs. These sequelae, in turn, drive work load and exacerbate burnout.