Is Your Doctor Burned Out? Nearly Half of U.S. Physicians Say They’re Exhausted

Burnout and poor work-life balance are a bigger problem for doctors than other professions

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Job burnout can strike workers in nearly any field, but a new study finds that doctors are at special risk. Nearly 1 in 2 U.S. physicians report at least one symptom of burnout, with doctors at the front line of care particularly vulnerable, the study found — a significantly higher rate than among the general working population.

Overtaxed doctors are not only at risk for personal problems, like relationship issues and alcohol misuse, but their job-related fatigue can also erode professionalism, compromise quality of care, increase medical errors and encourage early retirement — a potentially critical problem as an aging population demands more medical care.

The new findings, published in the Archives of Internal Medicine, are based on a survey of 7,288 physicians conducted in June 2011. Led by researchers from the Mayo Clinic and the American Medical Association, the study asked participating physicians to fill out a questionnaire asking about their feelings of burnout — including “emotional exhaustion” or losing enthusiasm for their work; feelings of cynicism or “depersonalization”; and a low sense of personal accomplishment. The 22-item questionnaire, called the Maslach Burnout Inventory (MBI), is considered the gold standard for measuring burnout; the doctors also completed a shorter, modified version of the MBI, the answers to which researchers used to compare with the general population.

Researchers also asked doctors how long they worked each week, how satisfied they were with their work-life balance, and whether they had any symptoms of depression or thoughts of suicide.

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The data showed that rates of burnout were high: 45.8% of doctors experienced at least one symptom of work-related burnout; when each symptom was considered separately, 37.9% of the physicians had high emotional exhaustion, 29.4% had high depersonalization and 12.4% had a low sense of personal accomplishment. U.S. doctors are burning out “at an alarming level,” the authors write.

“Our finding is concerning given the extensive literature linking burnout to medical errors and lower quality of care,” says study author Dr. Tait Shanafelt of the Mayo Clinic. “Most previous studies of physicians from individual specialties have suggested a burnout rate of 30% to 40%. Thus, the prevalence of burnout among physicians appears to be higher than in the past.”

The study found that practitioners of front-line care — including physicians in emergency medicine, general internal medicine and family medicine — fared worst. “Nearly 60% of physicians in those specialties had high levels of burnout,” says Shanafelt. “This is concerning since many elements critical to the success of health care reform are built upon increasing the role of the primary care providers.”

Doctors practicing pathology, dermatology, general pediatrics and preventive medicine (including occupational health and environmental medicine) had the lowest rates of burnout.

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The researchers also compared physicians’ job-related fatigue with that of 3,442 working American adults in the general population, and found that physicians were significantly more burned out overall. Among other working adults, only 27.8% were likely to experience burnout, 23.5% had high emotional exhaustion and 15% had high depersonalization.

The authors found also that physicians worked about 10 hours more per week than other people on average (50 hours a week versus 40), and were much more likely to work extra long weeks of 60 hours or more: 37.9% of doctors worked at least 60-hour weeks, compared with only 10.6% of the general population.

More than 40% of doctors reported dissatisfaction with their work-life balance, saying their jobs didn’t leave enough time for a personal life or family, compared with 23.1% of non-doctors. In addition, while higher levels of education were associated with less risk of burnout for people in other professions, doctors’ advanced degrees didn’t afford them the same protection from job-related stress.

“While individuals in other professions do experience burnout, it seems to be largely driven by the hours,” says Shanafelt. “In addition to their high work hours, there appears to be factors related to the nature of the work that increase the risk for physicians.”

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“Unfortunately, little evidence exists about how to address this problem,” the authors write, urging additional research to figure out what can be done to support doctors at the individual, organizational and societal level. “Policy makers and health care organizations must address the problem of physician burnout for the sake of physicians and their patients.”

24 comments
artaugen
artaugen

As a physician I am used to playing games with insurance companies who deny my claims so they can pay their CEOs ten million dollars a year.  I've learned to play that game.  But whats burning me out is the US government- specifically CMS the organization that runs Medicare.  Yes they are incompetent and yes they lack procedural analysis and yes an eight year old could write better software.  But to require a doctor to fill in the same form13 times in order to get paid goes way beyond incompetence.  It's called Evil.  Use your imagination to figure out why the know nothings in government don't want to give out money at this time.

artaugen
artaugen

As a physician I am used to playing games with insurance companies who try their best not to pay physicians claims so that their CEOs can make ten million dollars a year. I know the game and I play it well.  However a much bigger cause of "burnout" is the government agency CMS that runs Medicare.  Yes they are incompetent and yes they are clueless as to procedural analysis that any organization should have.  But nobody could be so incompetent so as to make a doctor fill out the same form 13 times in order to get paid.  That's not incompetence or stupidity- that's Evil.

Bilosopher
Bilosopher

My company is in the health insurance business and here's the issue: health insurance companies and drug manufacturers are whores.

The ONLY solution to the health care nightmare in America is a single payor system, like Medicare, where everyone contributes.

I cannot believe how dumbed down Americans have become - guess it's the product of three generations of public education where young people are graduated from high school and cannot read.

So, let's all keep buying into the BS that we're fed daily that we will have 'socialized medicine'. What do you think Medicare is??

All these old folks on Medicare know a GREAT thing when they experience it.

Oh, but we can't pay for it - how about we build a fewer aircraft carriers and F-35 programs - and mind our own business - for a change.

nvrtalk
nvrtalk

One symptom of "burnout" is not indicative of a "higher burnout rate".

And the trend is? Up down? How does this compare to past evaluations of physicians?

The only thing that worries me about this study is the lack of conclusive evidence and strong presence of conclusive conclusions making it to print.

Isaiah Horbert
Isaiah Horbert

The more I learn about the medical profession the more worried I become. I've had friends in college that come from families filled with doctors that frequently proclaim their hatred for the profession. From what I've heard, doctors only answer to the insurance companies. I like being busy, I never sleep anyways and if I feel like I'm actually helping people improve their livelihoods then I'm game. I just imagine the legal framework becoming increasingly complex as the "Affordable Care Act" rolls out. Yikes... 

Jim_Satterfield
Jim_Satterfield

One thing I'm curious about which is not mentioned in the article is how the environment the doctors work in relates to burnout rates. Is there a difference between doctors trying to keep a small or mid-size practice going and those doctors who instead work for hospitals or other health care organizations? Are there enough systems that work like the Billings Clinic or Mayo to see if that kind of system makes a difference?

Maureen_JBS
Maureen_JBS

A good resource for people going through workplace burnout is www.jobburnoutsupport.com.  This program has been designed by people who have been through burnout and fully understand the damage it can do.  It's aim is to help people get over burnout and get back to being their best again.

Maureen_JBS
Maureen_JBS

A good resource for people going through workplace burnout is www.jobburnoutsupport.com.  This program has been designed by people who have been through burnout and fully understand the damage it can do.  It's aim is to help people get over burnout and get back to being their best again.

NextPrez
NextPrez

Most US Physicians feel burned out unless there is a million dollar payout with lots of vacation time. Don't tell me that US Physicians work a lot. They hardly talk to patients and half of what they say is in garbled tones. Do you see any physicians spending more than 10mins in your appointment. They are always in a hurry to get to another patient so that they can fill their coffers. No, US physicians don't burn out. They are the greatest actors. You have to learn from Physicians in the developing countries and how they work, learn from Physicians in Kenya, India and South East Asian countries. These doctors have the selfless act of sacrifice. When you have taken the job you have to provide to your patients and not think of million dollar payouts and golf.

A_Doc
A_Doc

May be you should go to other countries and see that patients actually respect their physicians and listen to what they say. Not to mention, physicians actually have time to see patients there instead of worrying about proper documentation and legal consequences. People in US have high expectations that everyone should get everything they want and lets face it that is not possible. The reason your doctor doesn't spend more than 10 minutes is that he has another 20 minutes of paperwork and bs work to do after the visit, and many times they dont even get paid for the visit, so they schedule more patients. It would help if you actually recognized and shadowed a physician for a day to see how much they work instead of posting jargon here. Most doctors spend their first 25-30 years studying and learning to practice medicine while their education debt and interests pile up. I don't see anyone coming by offering to help there either. And don't you expect to be paid well if you spent that much time and efforts and early parts of your life working your behind off? So please find time to actually study what you're talking about. Being selfless doesn't mean working cheap and taking bs from everyone espcially citizens like yourself.

Mr Smith
Mr Smith

Many of the front line providers have adapted to lower reimbursement

rates by pushing patients presenting with more routine cases to

Physician’s Assistants. It is also obvious that physicians have

complete autonomy in calibrating their standard of living and lifestyle.

Any burnout is self-inflicted. The paperwork act is long overdue. The

clustering of diagnoses that implicate the Big Pharma will be just one

of the positive bi-products of bringing medical records into the digital

age.

The non-profit Costs of Care in Boston goal of educating

physicians on how the decisions they make impact what patients pay for

care would seem to be a more interesting story than the plight of

doctors and burnout.

Susan Crofoot Davis
Susan Crofoot Davis

So, Docs, which guy will you be voting for for prez?  Which one will help solve the problems you outline?  All the politicians talk about are social issues (like abortion, which affects a tiny percentage of the population).  What can doctors collectively DO to make changes to things they complain about?  What can I do?

zoonib
zoonib

Multinational corporations will be the death of us all. How can doctors make more money by working less. How can patients get better service for less money. Both of these problems will never be solved with the corporate middleman eating the biggest piece of the pie and leaving scraps for the doctor and patient.

matt newman
matt newman

....and declining physician salaries are making it increasingly difficult to justify the "burnout". Wait a second! I heard there's a doctor shortage that's projected to get worse. Could there be a connection???

zzlangerhans
zzlangerhans

I'm a physician and I can tell you exactly why this is. The practice of medicine is being taken over by various corporations who restrict what physicians do guided solely by a profit motive. Meanwhile, patients often have secondary gain issues related to procurement of controlled substances, unjustified disability claims, or the performance of inappropriate and expensive tests suggested by internet searches.

The corporations demand that we minimize expenses on these patients while fooling them with fake smiles and hand-holding so that they don't complain about us to the same corporations that are restricting their care. Meanwhile, the ever-present threat of malpractice litigation ensures that we constantly stride along a razor's edge between corporate satisfaction, patient satisfaction, and the practice of efficient and beneficial patient care.

Why do most of us keep doing it (those who do keep doing it)? For the money. I don't deny that I'm very well paid, and my compensation has actually been increasing as the corporate masters find it more and more difficult to find individuals who will submit to the ridiculous situation we have been placed in. And I will continue to turn the screws at every moment I can, constantly pressing for higher compensation and demanding double pay from the corporate wagegivers to fill in short-notice.

As soon as the corporations are no longer able or willing to provide the level of compensation I see as suitable for the unpleasant situations I am placed in on a daily basis, I will quit and pursue other interests, and I will take my twenty-five years of training and experience with me.

pbtoau
pbtoau

ZZ recognize your handle from Motley Fool.. funny.  Anyways, I'm an internist and echo the sentiment from my colleagues here.  I'm actually up late as with many  nights reviewing labs from patients, but trust me it's not the "hours" that get to us.  It's the amount of daily attrition of trying to apply our training in a industry now run by laypeople.  I always tell my staff that practicing medicine is the easiest, most enjoyable part of my day.  Up until the part where I realize that when I apply my training and expertise it is a distant second to the opinion of an administrator or a patient's preconceived opinion garnered from webmd.  Information technology is almost a misnomer.  As much as it advances healthcare it negates the positive by creating a swamp in which true practice of medicine is perpetually bogged.  I think to solve this most serious riddle we need to really think outside the box in terms of what we really mean by "access" and "outcomes".  On an aside I always recommend to my friends reading a book called "House of God" by Samuel Shem if you want a real perspective into the psyche of those who are practice medicine.  A wild but good read.

doctravel
doctravel

I'm a physician too, and every year I see more people making money in medicine that are not doing medicine.  While medical personnel net less, and medical bills for patients are skyrocketing. 

Medicare and Medicaid are befuddled and broken government agencies that know they are victims of fraud and abuse so they stab in the dark at all medical practices while they will not fix any of their own problems.  Medicare and Medicaid and are so complex that it takes a tremendous amount of personnel to bill and avoid or defend from rampaging audits.  The small town doctor is disappearing, unable to cope with the complexities of Medicare's ICD-9 coding system changing to the ICD-10 very complex system, the constant accusations of fraud, the student loan bills,  the malpractice institution, and no patients and certainly not MEDIA able to understand any of it.  

What are the salaries of Medicare and Medicaid administrators?  What do they do on any given day? What is ICD-10 and what does that mean to American medicine and the overhead costs to American doctors?  What is ANSI-50, why did Medicare require every American doctor to use it January 1, 2012, when Medicare wasn't ready for it?  What is Medicare fraud?  Why are good doctors doing it or being accused of it?  Why doesn't the MEDIA understand any of this?!! WHY? 

If we just paid for medical school, stopped the malpractice system, and simplified and cleaned out Medicare we would have a good medical system again with affordable health care, until that good luck!

 Jeremy Larsen
Jeremy Larsen

Maybe but what might look as being burned out might be him just knowing the sickness and diagnosing the problem, doctors see patients all day, they know when someone is sick and what to look for, diagnosing the problem with little enthusiasm does not mean they are burned out.

Mr Smith
Mr Smith

 

Many of the front line providers have adapted to lower reimbursement

rates by pushing patients presenting with more routine cases to Physician’s Assistants.

 It is also obvious that physicians have

complete autonomy in calibrating their standard of living and lifestyle. Any

burnout is self-inflicted. The paperwork act is long overdue. The clustering of

diagnoses that implicate the Big Pharma will be just one of the positive bi-products

of bringing medical records into the digital age.

The non-profit Costs of Care in Boston goal of educating

physicians on how the decisions they make impact what patients pay for care would

seem to be a more interesting story than the plight of doctors and burnout.

Sara Rose
Sara Rose

If anything, my own doc is burned out on golf, skiing and European vacations. I have no sympathy for this breed of overcompensated whiners.