The Burden of Physician Burnout: Why The Rates Continue to Rise
It's no new fact that physicians experience burnout at a higher rate than the rest of the U.S. population -- 37.9% compared to 27.8%, according to a recent study in Achieves of Internal Medicine -- and that emergency medicine physicians rank higher than any other medical specialty. What's even more concerning, physicians, especially residents, also report higher suicide rates than the general population, however only 26% of physicians who report suicidal thoughts seek help.
It's an ever-growing issue that the American College of Emergency Physicians (ACEP) has taken notice of. The inaugural EM Wellness Week began on Sunday, January 24th and will continue until Saturday, January 30th. The goal of this week is to bring the focus back onto well-being of the care-giver and improve wellness throughout the specialty by offering tips to improve wellness physically, through personal relationships, and career enhancement.
As part of our own participation in EM Wellness Week, we recently discussed ways to identify burnout as an emergency physician. This was based on the Maslach Burnout Inventory (MBI) which has been recognized for over a decade as the leading measure of burnout and takes factors such as emotional exhaustion, depersonlization, and personal accomplishments into consideration.
These identifiers of burnout are a high-level look at the issue, but what's more important to consider when discussing the ever-rising rates of burnout in emergency physicians are the contributing factors they acknowledge themselves.
Why Are Physicians Feeling the Burden of Burnout?
According to Medscape’s 2015 Physician Lifestyle Report, the following factors were rated on a scale of 1 to 7.4 as the top contributors to burnout:
- Bureaucratic tasks are the top cause of burnout at 4.75.
- Long work hours and insufficient compensation came next at 3.99 and 3.7, respectively.
- The effects of health care modernization also play a role in burnout: computerization was ranked 3.68, and the Affordable Care Act’s impact was 3.65.
- Patient concerns also contribute to burnout, with difficult patients at 3.37 and too many patients at 3.34.
- Lack of professional fulfillment was lower on the list, ranked at 3.05.
While eliminating workplace stress through cognitive-behavioral training, mental relaxation, and physical relaxation can help reduce the effects of burnout, one could argue that they are merely band aids that don't address the root of the issues above.
Roger S. Perry, MD, PhD, FACEP offered up this opinion in response to an article on The Health Care Blog, "After 40 years of full time emergency medicine practice I have just cut back my hours in the pit, now also known as a Toxic Environment. To me the solution to burnout is not in psycho-therapy, increasing ones recreational activities, increasing more time with family or friends, etc., the solution lies in ridding our emergency departments of the toxic elements that are poisoning us."
An overwhelming number of physician comments on this subject echo Dr. Perry's view...
Dave Bryant, DO, FAEEM offers this opinion, "Burnout is different than being burned up. Burnout implies that you are tired of your profession. Many of us are not tired of being doctors. We love our profession. We are tired of having artificial stressors placed on us that have no bearing on the practice of medicine...Physicians used to drive improvements in healthcare. Now, we are being pushed out in favor of protocols, midlevels and computers."
Joel Sullivan, MD, FACEP offer a similar viewpoint, "The volume of patients has gone up and in the meantime we have to document and enter all orders on a computer. In addition to taking care of the patients, one is now doing the job the unit secretary used to do – you can no longer just check orders on a piece of paper and give it to the secretary to order same."
These comments only represent one side of the conversation however.
Others agree that while there are challenges facing the healthcare system, the focus needs to be on the training of young physicians to help them find a way to survive in the current environment of modern medicine.
Samantha Meltzer-Brody, MD offers this opinion in her article Physician Burnout: It's Time to Take Care of Our Own, "Despite interventions focused on reducing resident duty hours and sleep deprivation, neither of these factors have been associated with reductions in burnout. New approaches are needed to combat this epidemic and provide appropriate mental health care."
She goes on to suggest that there is a stigma among physicians associated with asking for help for emotional problems. This stems from concerns about confidentiality, worries that colleagues may find them inadequate or incompetent or fear that they are failing if they are unable to "handle the stress."
The topic of physician burnout is a complicated one and in no way has been addressed fully here, however it's important to note that the conversation is happening. Continued research into the sources of and ways to help prevent burnout, in addition to providing proper solutions to physicians to combat it, will ultimately play the biggest role in reversing the current trend.