Burnout burden high among US physicians

Andrew F. Stewart, MD

This is an interesting and important paper documenting that burnout and adverse work–life balance issues affect physicians disproportionately as compared to other US workers; and to explore the reasons for this. The results suggest, with appropriate cautions regarding limitations and confounders, that certain specialties within medicine are more severely affected than others. 

With regard to the field of endocrinology, no specific information is available, since the many disparate general internal medicine subspecialties are combined into a single group. Thus, high-earning proceduralists (eg, cardiology, pulmonary, GI physicians with better personnel support systems) are lumped together with lower earning RVU/E&M coding non-proceduralists (eg, rheumatology, endocrinology, infectious disease physicians with little personnel or other ancillary support). One might reasonably infer that endocrinologists are most akin to family practitioners and general internal medicine physicians who are disproportionately affected by burnout and work–life balance issues. The authors may want to share their database with subspecialties for subset analysis, or analyze it more deeply themselves to see whether trends exist in specific subspecialties. This information would be of value to the Department of Health and Human Services, the AMA and other agencies interested in managing and financing health care reform. 

As the authors point out, most studies in this area offer little in the way as to guidance regarding burnout- and life balance-prevention measures, other than counseling and support measures, and fail to address the organizational, procedural and support issues that lead to the occurrence of what is an obvious problem.

As they also point out, work–life balance issues and burnout predict both work force dropout and lower levels of quality of patient care.  There is no attempt to quantify these in the current study. This would be an attractive area for further study.

Overall, this is a timely and important study, although much more remains to be done analytically, and also with regard to interventions.

Helena W. Rodbard, MD, FACP, FACE

This is a critically important paper. It has dramatic findings that should be very depressing to physicians, patients, health care system managers and society at large. It should be read by everyone involved in attempting to reform our health care system.

It documents the impending ‘death’ of the medical profession, with a shockingly high frequency of burnout and depression, especially among primary care physicians and general surgeons. Physicians are seriously overworked — working a median of 50 hours per week compared with the general population of 40 hours per week. They have less job satisfaction, and a lower quality of balance of work and life. There is a seriously increased risk for depression.

With these findings — which had been discussed anecdotally for many years, who in their right mind would want to enter the field of medicine? As bad as the situation is now, it is likely to get much worse over the next few years, with the advent of more regulations and restrictions by government and payors, increased workload and paperwork, increasing demands on physicians’ time, diminishing remuneration, loss of autonomy, independence and prestige, restrictions on modalities of therapies available, impending acquisition by Accredited Care Organizations and many hospital and university systems, mandatory use of electronic medical records that uniformly and substantially reduce the productivity of physicians, resulting in longer workdays, less time with the patients. Physicians are completing their training with larger levels of indebtedness, and the profession has lost prestige: Physicians are now ‘providers’ and barely coequal many others with less education, expertise and abilities. The patients’, governments’ and payors’ expectations and demands continue to increase.

It would be important to repeat this study every 2 years to monitor trends. It would also be important to analyze data from various medical and surgical subspecialties, and to relate happiness and burnout to levels of compensation, work load, amount of time spent in the typical or average patient–physician encounter, and levels of appreciation from patients and society at large.

If society is treating physicians in this despicable manner now, and the situation seems to be getting worse, access to care for the typical American is likely to deteriorate rapidly. Many public health specialists have been busy ‘blaming the doctor’ for the ills of the health care system for so long. Now it is time for everyone to realize that without the doctor, there is no meaningful health care system, and society must work actively, aggressively and creatively to improve conditions for those in this dedicated, devoted, downtrodden, industrious, essential and noble profession.

Harry S. Jacob, MD, FRCPath(Hon)

I suspect — actually, I’m sure — that similar studies done “before medicine became a business” (a quote from William B. Castle 3 decades ago) would be astonishingly different. Burnouts were far less common, methinks, before insurance company battles, doctor-patient-visit time restraints, MBA-oriented department chairmen, etc, deflected our mission of compassionate service.