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The Physician Burnout Epidemic: What It Means for Patients and Reform
http://www.theatlantic.com/health/archive/2012/08/the-physician-burnout-epidemic-what-it-means-for-patients-and-reform/261418/
In a large analysis published this week in Archives of Internal Medicine, researchers at the Mayo Clinic surveyed 7,288 physicians on their quality of life and job satisfaction. The results are striking -- 46 percent of respondents reported at least one burnout symptom. The report indicates that doctors, as a group and relative to other highly educated individuals working similar hours, suffer high levels of emotional exhaustion and struggle to find a satisfying work-life balance.
"This matters not just for physicians, but for patients," says Dr. Tait Shanafelt, a professor at the Mayo Clinic in Rochester, MN and senior author of the paper. Burnout can diminish professionalism and lessen the quality of care. At the same time, it leads doctors to reduce their hours and retire early. "We're at the cusp of reform," he said. "Precisely when we need more family and internal medicine doctors, students are more likely to enter other fields. This issue has implications for the adequacy of the physician workforce."
"It's a really big problem," confirms Dr. Vineet Arora, a faculty member and residency program director at the University of Chicago. She has studied physician fatigue and professionalism. "The issues for doctors in training aren't necessarily the same as for those who are in practice," she says. After residency or fellowship, doctors are older and have less supervision. "There's a recipe for burnout because of the long hours and high workload," she says. "Most health care systems don't provide joy and sustainability in the workplace," she said. "In that case, it doesn't matter happens during education and training. The delivery system has to change."
The investigators used a standard evaluation tool called the Maslach Burnout Inventory to assess physicians' wellbeing. As the authors acknowledge, one limitation to the study is the low response rate. Initially the investigators tried contacting nearly 90,000 physicians nationwide. Among those, 27,000 indicated they'd received an email. Among those doctors, only 7,288 - less than 10 percent of the original sample, or 27 percent of those who received the survey - completed the questionnaire. Although most of the doctors contacted did not complete the questionnaire, Shanafelt stands by the conclusions. "The surveyed sample was representative of the larger group initially contacted," he said. The groups were similar in terms of the doctors' age and gender, and how long they'd been out of medical school. "We didn't just get extreme responses," he adds. "We got the full spectrum - folks who are very satisfied, and very unsatisfied. There was a continuum."
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