• Physician burnout is a big deal

    I’ve written extensively about physician job satisfaction. There’s a new study out in JAMArchives of Internal Medicine that adds to the discussion:

    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.

    Researchers sent out surveys to over 27,000 physicians, and about 27% of them answered them. The news isn’t good.

    They used the Maslach Burnout Inventory, which is a validated measure  of burnout. More than 45% of of doctors had at least one symptom of burnout. The highest rates of burnout were seen in physicians considered to be at “the front line” of access, including emergency medicine (about two-thirds of them!), general internal medicine, and family medicine.

    When assessed against a probability based sample of US workers in other professions, physicians fare significantly worse. About 38% of physicians have burnout compared to 28% of all other workers. About 40% of physicians are unhappy about their work-life balance compared to 23% of all other workers.

    We need to take this seriously. Unhappy doctors don’t make for good doctors. I wish we could spend a little more time talking about this in the public sphere instead of how doctors might only make decisions because of money.


    • Seems like yet another reason to make it easier and cheaper to become a Physician. The gauntlet the they need to run become Physicians seems ridiculous and for many reasons it seems that we need to have more people able to practice. IMO there should be enough that some significant percent are unable to get jobs as Physicians. This just like all lawyers are not able to find work as lawyers. This the case in most professions and it enables that dropping of the worst.

    • So we’re comparing an estimate of doctor burnout derived from a survey with a 27% repsonse rate to a survey of other workers with an ungiven response rate, and we’re supposed to assume that a 10% gap is statistically significant?

      • Regardless of the “gap” if about 2 out of 5 doctors (GPs, etc) are “burning out” that seems like a concern.

        If 4 out of 5 grocery cashiers were burning out, I wouldn’t think it a serious problem for the general public, even though the percentage is twice is large.

        • If 4 out of 5 grocery workers were allegedly burning out, I wouldn’t consider it a big problem because every time I go to the grocery store, I still see lots of workers.

          Who am I supposed to believe, a survey or my lying eyes?

          Look, I don’t just like surveys, I love them. I work with them every day of the week as part of my job. But if I did a mail survey and got a 29% cooperation rate, I’d be VERY skeptical about this sample being representative of the population.

          • While I usually would agree with you, and strive to go over 50% in my own surveys, this is a pretty normal response rate when it comes to physicians. There’s a lot of research on the methodology.

            • From what (little) I’ve seen, it’s a pretty common rate for mail surveys in general. If you’re able to keep your response rates above 50%, I’m impressed.

              My question is, from the research on this methodology, does it actually appear that a response rate of 29% is generally representative? I’d find that surprising on a topic like burn out, where I’d think that those who are burned out might be more motivated to respond.

              Still, I don’t know any of this literature dealing with mail surveys to doctors, and it drives me bonkers when people who don’t know the details of technical matters casually dismiss those who do.

              Thanks, btw, for being active in the comments here.

    • To me these results suggest that some physicians might accept lower pay in return for fewer hours. That may be one of the few ways to lower health care expenditures without making someone unhappy.

      • Only if they lowered their pay by more than they lowered their work effort. And even then, you’ve now got to find more doctors to cover those no longer being seen by their original doctors.

        • I am not suggesting that physicians see fewer patients, but I am suggesting that that there is a reasonable possibility that there are, or will be, ways to reduce the number of physician-provided services per person: using automated interactive websites to screen some patients, eliminating unnecessary procedures, making greater use nurse practitioners, better patient education ( by both individual providers and the media)etc. The chances of reducing the number of procedures/contacts per person may be greater in some areas of medicine than in others.

          • I don’t see how to reconcile your original statement, “…some physicians might accept lower pay in return for fewer hours” with the follow-up “I am not suggesting that physicians see fewer patients”. To my way of thinking, fewer hours worked = fewer patients seen.

            I guess you could say that if I am a patient of doctor X and I go from seeing X every other week for this or that to seeing him every 4th week and using his automated website for the other visit, then he’s still “seeing” (where seeing = caring for) me.

            • To give you a hypothetical example ( I have no idea what the real numbers are) lets say that the average physicians see 300 patients an
              average of 5 times each a year. Reducing the workload might mean seeing fewer patients, but it could also mean reducing the average number of visits to 4.5.

      • I have enough patients who are angry at me because they have to wait a couple of days to be seen. You think seeing FEWER patients will help?

    • It sounds as though there is confusion between _having a symptom of burnout_ and _having burnout_, Rather different beasts. This sort of confusion (counting folks who _report_ one aspect of something as having that something and going all world-is-coming-to-an-end newspaper article on us) sets of my BS detectors something fierce.

      Still, the wiki article on burnout* says that GPs have the highest burnout rate, so this isn’t news. On the other hand, if you offered doctors a world with an easier path to becoming an MD, more MDs in the world, less work, and less money and prestige, I’d guess that most of those who had already made it to MD status would prefer the status quo…

      *: http://en.wikipedia.org/wiki/Burnout_(psychology)

    • The study you allude to is published in the Archives of Internal Medicine. Though this is a publication of the American Medical Association it is not the Journal of the American Medical Association.
      The study in question was reported extensively. Is this a Fareed Zakaria moment?