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Physician Burnout

Ongoing stress may lead to burnout and with April being Stress Awareness Month, physician burnout is a timely and important topic. Physician burnout signifies a public health crisis and is defined as emotional exhaustion, depersonalization and a sense of reduced personal accomplishment. It has a negative impact on physicians’ well-being, patient care and health care organizations. It may lead to increased error, reduced quality of patient care and satisfaction, and increased cost.

Physicians’ satisfaction with work-life balance is only 40.9% compared with 61.3% in the rest of the workforce and they have a higher rate of burnout (54.4% vs 28.4%).

In the Medscape National Physicians Burnout and Depression report of 2018 from more than 15,000 physician surveyed, 42% had symptoms of burnout and 12% admitted to have depression, which is twice the national rate. The rate of burnout was highest in critical care specialty (48%), lowest among plastic surgeons (23%) and right in the middle for nephrologists (40%).

Burnout has been related to physicians’ physical withdrawal from the clinical workforce by reducing to part-time, restricting the scope of practice, retiring, or rerouting to non-clinical work or another career. There are an estimated 300-400 suicides among physicians each year. There are skeptics about the burnout statistics but no one can deny that physicians have a higher rate of suicide (approximately 40% higher for male physicians and 130% higher for female physicians as compared with the general population).

There are many factors contributing to physician burnout which could be grouped into seven categories: workload, efficiency, flexibility/control over work, work-life integration, alignment of individual and organization values, social support/community at work, and the degree of meaning derived from work.

The drivers for burnout include excessive workload, inefficient work processes, clerical burdens, work-home conflicts, lack of input or control related to work.

Some healthcare institutions and organizations have been trying to proactively reduce burnout and improve engagement of physicians. They see this crisis as a threat for well-being and survival of their organization.

There are others who see this issue as solely physicians’ responsibility. Although there is no consensus in the best effective way to deal with this dilemma, in my opinion, there must be a collaboration between physicians and healthcare organizations for prevention and management.

Mayo Clinic is one of the pioneers in this endeavor by establishing the Office of Staff Services (OSS) that provides financial services to 75% of their eligible staff and peer support to 5% up to 7% as needed.

The hospital that I am affiliated with has contracted with a third party organization dedicated to physician services similar to Mayo Clinic OSS; however unfortunately, the majority of the physicians are not aware of it or has never used their services.

Individual management of burnout starts with identification. Although depression may accompany the burnout, they are different and should not be confused with one other. The most accepted standard for burnout is the Maslach Burnout Inventory (MBI), which includes a Human Services Survey applicable to healthcare professionals. It includes emotional exhaustion, depersonalization and personal accomplishment domains.

In my opinion, mindfulness could be the best way to identify the symptoms of burnout and its management. There are mindfulness training retreats available to the public and ones specifically for physicians.

In summary, physician burnout is prevalent and it has negative consequences for individual physicians, healthcare organizations, and patient care and satisfaction. Prevention and interventions should be shared between physicians and healthcare institutions. Physicians need to be mindful of burnout symptoms and utilize available resources to help prevent the negative and, at times, grim consequences.

Ehsan Shahmir, MD

Ehsan Shahmir, MD

Ehsan Shahmir, MD, serves as group medical director for DaVita Kidney Care and has been with DaVita since 1995. He is also a practicing nephrologist in Vacaville, California, is the chief of the department of nephrology at NorthBay Medical Center, and is a member of NorthBay’s bioethics committee and physician wellness committee. Previously he served as NorthBay’s vice chief of the department of medicine and a member of their peer review committee. Dr. Shahmir received his medical degree from Tehran University School of Medicine in Iran and finished his fellowship at Harbor-UCLA.