Physician burnout taking center stage
By Linda Carroll
(Reuters Health) - The medical establishment may finally be coming to grips with the issue of physician burnout. The evidence: two studies on the topic released online Tuesday in the Journal of the American Medical Association.
One study found that nearly half of junior physicians were already having burnout symptoms at least one day a week.
The other study underscored how hard it is to assess the problem. After reviewing previous studies, researchers found huge variations in definitions of burnout and estimated rates among doctors.
"With two lead articles in one of the most prominent medical journals in the world, it means that burnout is now being taken seriously by the medical mainstream," said Dr. Albert W. Wu, an internist and professor of health policy & management at the Johns Hopkins Bloomberg School of Public Health in Baltimore, Maryland.
"It is being endorsed at an alarming rate by physicians who range from trainees to seasoned veterans and it is accompanied by other disturbing correlates that include a high rate of suicidal ideation, regret about one's job choice and an acknowledgement of not being one's best self in practicing medicine," Wu said. "This represents a crisis in slow motion."
Doctors' workloads have changed considerably over the years. Today they spend less time with patients and "a lot of time trying to get authorizations for treatment that they know their patients need and insurance companies won't pay for," Wu said. "Insurance companies and others have discovered the way to get doctors to order fewer tests and medications is to make it a huge hassle to get them."
This may partly explain why nearly 50% of medical residents reported burnout at least one day a week. And a large number felt they had made a mistake in choosing a subspecialty, such as pathology or anesthesiology, or even medicine in general as a profession.
That study followed 3,588 physicians, who were surveyed during their last year of medical school and again in their second year of residency. Along with a host of demographic questions, the doctors were asked to rate themselves on two statements: "I feel burned out from my work" and "I've become more callous toward people since I started this job."
Those questions were designed to capture two of the three symptoms that fit the classical definition of burnout: exhaustion and feelings of depersonalization. The third symptom would be a low sense of personal accomplishment.
Residents were also asked two questions designed to illuminate regrets they might have about their careers: "If you could revisit your career choice would you choose to become a physician again?" and "If you could revisit your specialty choice, would you choose the same specialty again?"
Overall, 45% reported at least one symptom of burnout at least once a week, while 14% reported career choice regret.
While once a week may not sound like a lot, physicians who feel burnout this often are more likely to report thinking about suicide, making a major medical error and wanting to leave medicine, said lead author Dr. Lotte Dyrbye, who co-directs the physician well-being program at the Mayo Clinic in Rochester, Minnesota.
"Burnout is very much a real thing" among physicians, Dyrbye said, noting that while doctors may have close to a 50% burnout rate, among other U.S. workers the rate is under 30%.
Still, Dyrbye said, "We need more research in the field with good attention to method."
The authors of the other JAMA study would likely agree. They originally planned to conduct a meta-analysis. But after gathering 182 reports involving 109,628 physicians from 45 countries, they determined that the definitions of burnout and the study methods were so disparate that it was impossible to draw any conclusions.
For example, "some studies will label someone as burned out if they feel exhausted one day out of the week," said coauthor Dr. Douglas Mata of the Brigham and Women's Hospital and Harvard Medical School in Boston. "Others . . . only label you as burned out if you are exhausted and feel depersonalized and have a low sense of personal accomplishment every day."
Mata says researchers need to find the best way to quantify physicians' responses to chronic occupational stress. "The concept of burnout is useful because it conceptualizes workers' responses to systems," he said. "It doesn't suggest that you need to treat the (worker) but rather to fix the work environment."
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