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According to a 2018 report, over 50% of physicians and physicians-in-training in the United States experience burnout in the workplace. Physician burnout has been directly linked to negative effects on patient care, physician health, and the healthcare system overall. (8) This high rate of burnout demonstrates the dire need for solutions and interventions to better support physicians and the healthcare system.
What is burnout in healthcare?
Physician burnout generally presents itself as a mix of emotional exhaustion, depersonalization with patients, and a diminished sense of personal achievement at work. As a result, physicians may feel like they have nothing to offer, treating patients more like objects, with a lack of empathy, rather than as humans. Physicians also may start to feel like their treatments are ineffective, and they may undervalue their professional achievements. (8)
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Physician burnout can be caused by many different factors, from inefficient work processes and administrative tasks to lack of sleep and job stress.
Long hours at work
In a survey study of about 7,900 surgeons, the rate of physician burnout was directly related to the number of hours worked per week. Surgeons who worked less than 60 hours per week had a burnout rate of 30% compared to 44% among surgeons with work hours between 60 to 80 hours per week. (3)
Electronic health records use
One specific work process that has a major impact on physician burnout rates is the use of electronic health records (EHRs). A review of 30 studies found that poor platform design, along with platforms that have too many capabilities to keep track of, can cause additional stress for physicians. (4)
The extra workload of notetaking and electronic communication also creates overtime work. Combined with alert fatigue from inbox notifications, medication refills, and test results, what may be a helpful tool in a physician’s practice can also add to the administrative burden, leading to burnout. (4)
Sleep loss from shift work
Shift work is necessary among emergency medicine practitioners to fill the 24-hour need for care; however, it disrupts the body’s circadian rhythm which can lead to sleep loss. Not only can sleep loss cause physician burnout but it can also lead to numerous other negative health consequences such as an increased risk of cardiovascular disease, sleep disorders, metabolic syndrome, and possibly even death. (7)
One survey of five cohorts found that 84% of emergency medicine residents felt that they needed an intervention due to sleep deprivation and exhaustion. The effects of shift work are felt as early as residency and only increase with age. (7)
Gender and age
Research shows that higher rates of physician burnout have been reported among female and younger physicians. (8) One survey studied a faculty of just over 1,000 physicians, 46% of whom were female. The results found that 42% of female physicians felt burnt out compared to 34% of male physicians. This significantly higher burnout rate in female physicians may be linked to lower reported rates of self-compassion and perceived appreciation in the workplace among female physicians. (5)
Work-home conflict
Work stress or conflict extending into a physician’s personal life can also lead to burnout. This can occur when a physician’s work causes them to miss out on family activities or meals, spend less time with their partner, or create conflict related to child care. (3).
A survey found that physician burnout was more likely to occur in two-career families, especially when both spouses were physicians with highly demanding jobs. (3)
Physician burnout by specialty
Burnout may affect physicians of various specialties differently based on their day-to-day tasks; however, all physicians from primary care to specialty care are vulnerable to burnout symptoms. About 60% of family medicine practitioners experience physician burnout. Among gastroenterologists, around one-third have reported feeling symptoms of burnout. (3)
Another survey found that the specialties with the highest burnout rates were emergency room (52%) and critical care physicians (50%). The lowest rates were in psychiatrists (33%) and pathologists (32%). (3)
A meta-analysis also found that physician burnout specifically linked to patient safety issues was highest in physicians aged 20 to 30 and physicians working in emergency medicine. (2)
Symptoms and signs of physician burnout
There is a wide range of ways physician burnout can present. Some symptoms become increasingly dangerous with the severity of the burnout. The most common effects and symptoms of physician burnout include:
Alcohol and drug abuse
Depression (3)
Depersonalization with patients (8)
Difficult relationships with coworkers
Divorce (3)
Emotional exhaustion (8)
Medical errors
Patient dissatisfaction
Physician attrition (3)
Reduced sense of personal accomplishment (8)
Suicide (3)(7)
Did you know? Each year more than 400 physicians commit suicide—an issue thought to be associated with the increase in mental health struggles and burnout. (7)
How to prevent physician burnout
With the numerous factors that can cause and contribute to physician burnout, it’s important for burnout prevention efforts to come from both the individual and organizations.
Recognize the signs and symptoms
Being aware of the signs and symptoms of physician burnout can help physicians recognize it faster in both themselves and their colleagues. The faster burnout is recognized, the sooner steps can be taken to halt its progress, avoiding potential physical and mental health consequences for the physician. Incorporating burnout into medical education can aid in keeping physicians vigilant and promoting optimal patient care.
Practice self-care
When caring for so many patients, it can be easy for physicians to deprioritize their own health. However, focusing on your health and personal life outside of work can make notable differences.
Self-care can include getting frequent exercise and sufficient sleep, staying connected to family and friends, and learning to say no to additional administrative burdens when you don’t have the capacity for them. (3) Mindfulness practices have also been shown to reduce doctor stress levels. (8)
Additionally, taking vacation days and completely disconnecting from work supports a healthy work-life balance. This can positively affect mental health, resulting in workers feeling that their energy levels are recharged and that they are more productive upon their return to work. (3)
Practice self-compassion
Practicing self-compassion is also very important. This involves noticing negative self-thoughts and learning to replace those with compassionate thoughts like those you might offer to a loved one or a patient in the same situation. (6)
Reflect on your career and values
Frequently reflecting on your medical education and career is another recommended practice. Medicine and the healthcare industry are always changing, so physicians should always assess whether working in medicine still brings them positive value and job satisfaction.
Noticing what brings value can allow physicians to embrace those aspects of their day-to-day and feel reaffirmed in their work. If the value is no longer there, acknowledging this can help begin the process of making changes to find it again. (6)
Organizational solutions for burnout prevention
It’s vital for physicians to feel supported by their organizations and the healthcare system. Introducing practice modifications and increased support for clinical workers have both been shown to be beneficial in preventing physician burnout and reducing burnout rates. (8)
Real-life strategies for burnout prevention
One pediatric medicine professor in Rhode Island described how they left the daily practice of medicine after a decade of feeling frustrated and burnt out. They always felt like they were failing because they struggled to keep up with the workload added by using an EHR and never being able to get through everything in their inbox.
This physician found embracing creative outlets, like cooking, painting, and sewing, to be a coping strategy because they encouraged the freedom to do without rules of what they should be doing. They also found that supporting residents and medical students not only made them feel better but also allowed the students’ fresher positive outlooks to rub off on them as well. (1)
A pediatric oncologist from New York has found it helpful to disconnect over the weekend and allocate time during the week for non-work-related activities. She has acknowledged that despite loving and finding fulfillment in her job, not having a work-life balance negatively impacts her health, sleep, and relationships.
She also tries to designate certain tasks, like answering emails, to a certain time of the day. She reminds herself that not getting to someone’s email or finishing a clerical task until the next day won’t jeopardize anyone’s life. (1)
Physician burnout is a major problem with significant consequences on physician health, patient care quality and outcomes, and the healthcare system overall. Recognizing the signs and symptoms and introducing measures for preventing physician burnout is vitally important so we can reduce these numbers and achieve the healthcare system’s main goal—health.
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The information in this article is intended for healthcare practitioners for educational purposes only, and is not a substitute for informed medical, legal, or financial advice. Practitioners should rely on their own professional training and judgement, and consult appropriate legal, financial, or clinical experts when necessary.
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