Are You Feeling the Heat of Professional Burnout? You Are Probably in Good Company!
Abstract & Commentary
By Jeff Unger, MD, Director, Metabolic Studies, Catalina Research Institute, Chino, CA. Dr. Unger reports no financial relationships relevant to this field of study.
This article originally appeared in the Jan. 29, 2013, issue of Internal Medicine Alert. It was edited by Stephen Brunton, MD, and peer reviewed by Gerald Roberts, MD. Dr. Brunton is Adjunct Clinical Professor, University of North Carolina, Chapel Hill, and Dr. Roberts is Assistant Clinical Professor of Medicine, Albert Einstein College of Medicine, New York, NY. Dr. Brunton serves on the advisory board for Abbott, Boehringer Ingelheim, Janssen, Novo Nordisk, Sanofi, Sunovion, and Teva; he serves on the speakers bureau of Boehringer Ingelheim, Kowa, Novo Nordisk, and Teva. Dr. Roberts reports no financial relationship to this field of study.
Synopsis: A total of 27,276 U.S. physicians received an invitation to participate in a prospective study using the validated Maslach Burnout Inventory. Of the 26% of physicians who completed the survey, nearly 46% reported at least one symptom associated with professional burnout. Family physicians, internists, neurologists, and emergency department physicians appeared to be at highest risk for burnout. This study found that 37.9% of all physicians were likely to have symptoms of burnout compared with 27.8% of non-medical working adults.
Source: Shanafelt TD, et al. Burnout and satisfaction with work-life balance among US physicians relative to the general US population. Arch Intern Med 2012;172:1377-1385.
This was the first national study that evaluated and compared rates of burnout among U.S. clinicians by specialty with non-physician U.S. workers. Table 1 summarizes the most notable conclusions of this study.
Few primary care physicians (PCPs) believe that this trend is likely to be reversed in the near future. Having 21 million patients deposited on our doorsteps as the result of the Affordable Health Care Act is likely to result in loss of autonomy, reduction in compensation, increased federal regulations, and higher medical-legal exposure. Patients are likely to become more demanding of a medical system that will be unable and unwilling to provide timely interventions to those in need. More pressure will be placed on PCPs to provide efficient, evidence-based care to patients with chronic illnesses. Unfortunately, even the most intelligent and organized clinicians will be hard pressed to provide care for a new patient with diabetes during a single 10-minute office appointment! With all of the demands that are placed on each of us, especially solo practitioners, I am surprised that not more of our colleagues are experiencing burnout. Remember our first day on the job? The first patient you ever saw professionally? The first baby you ever delivered? The first life you ever saved? The first real diagnosis you ever made? The first hand you held of a dying patient? The first time you ever sutured a wound or assisted in surgery? How exciting and memorable were those experiences? Remember the first pay check you received as a “real doctor?” My father received a check for $15 as a resident working at Cook County Hospital back in 1950. Back then, they did not pay the interns who were expected to work 80 hours a week. My dad said he cannot remember any of his fellow interns ever experiencing burnout. The residents who earned $15 per week did not experience burnout or depression either. They were simply excited about being doctors.
Table 1 U.S. Physician Burnout Talking Points
Now, times are so very different. My father had to retire from the practice of medicine this year at age 85. He could have worked longer, but he said, “it isn’t worth it anymore.” There are so many more regulations and busy work that we must do on a daily basis that we are lucky to get home before 9 p.m. When the doors to the office are finally closed and the staff is discharged, the practitioner or his designated associate must enter data related to meaningful use, PQRS, and other performance parameters into the computer. Failure to e-prescribe, maintain board certification, and supply Medicare with these parameters will result in financial penalties further reducing per-patient compensation. In 2013, the Centers for Medicaid & Medicare Services (CMS) estimates that the statutory formula used to determine Medicare physician payments will result in a decrease of 27%!1
Burnout in any profession occurs when one’s job becomes overwhelming or if one is unable to control his/her own destiny. Physicians work long hours and are forced to spend inadequate time with complex patients. Patient-centered medical homes may offer PCPs the option of seeing fewer patients on a daily basis in an efficiently organized practice that may be income generating.2,3
I believe that the major triggers for physician burnout in the United States are: 1) the CMS; 2) private insurers who base compensation on CMS recommendations; 3) government regulations that increase health care costs and reduce treatment efficiency; and 4) increased taxes on small businesses that result in our inability to hire new personnel, purchase new equipment, or even take time off to enjoy a week or two with our family. Until working conditions and compensation for frontline specialists improve, more of us will burnout and suffer from major depression.
1. Proposed 2013 Medicare Physician Fee Schedule. http://www.aafp.org/online/etc/medialib/aafp_org/documents/policy/fed/background/mpfs071212.Par.0001.File.tmp/MPFS071212.pdf. Accessed Nov. 22, 2012.
2. Reid RJ, et al. Patient-centered medical home demonstration: A prospective, quasi-experimental, before and after evaluation. Am J Manag Care 2009;15: e71-e81.
3. Introduction to diabetes. In: Unger Jeff. Diabetes Management in Primary Care – Second Edition. Philadelphia: Lippincott, Williams and Wilkins; 2012: 1-37.