A recent study published in the Archives of Internal Medicine raises alarms about stresses being placed on physicians in the current health delivery system. Symptoms of burnout are far more common among physicians than other workers. Physicians who specialize in front line and primary care services are at the greatest risk.
The findings of the study raise many concerns. Levels of burnout in US physicians are extremely high; primary care providers and emergency providers seem at the highest risk; physicians work longer hours than other workers; physician have greater struggles with integration of work and life issues than other workers; in fields outside of medicine, high levels of educational attainment seem to be protective against burnout, but this is not the case in medicine. Burnout among physicians is a unique entity and does not reflect societal trends.
Serious personal consequences can result from physician burnout. These can include problematic alcohol use, broken relationships, and suicidal ideation. Increasingly there is a consensus that burnout can effect quality of care. These findings suggest an alarming problem of systemic proportion for the health delivery system as a whole.
With an almost 50% rate of burnout symptoms reported in US physicians it is clear that the etiology of this problem is within the care delivery system itself.
This fact has important implications for policy makers and health delivery systems which must address this issue head on, for the sake of physicians, patients and the delivery system as a whole.
Burnout and Satisfaction With Work-Life Balance Among US Physicians Relative to the General US Population
COMMENTARY: Taken on face value, one could argue that this is nothing new. The practice of medicine has always required intense training, dedication and neglect of many of the things in life that others take for granted. Having said that, the environment today has never been more challenging.
Physicians are subject to an endless barrage of demands which include: certification and repetitive re-certification, medical-legal exposure with every patient encounter, ever growing demands for documentation of ALL aspects of the interaction with patients, ever growing demands for translation of clinical interaction into complex coding language in order to bill and “hope” for payment, skewed and arbitrary fee schedules and payment policies which vary widely between state, federal and private payer entities.
The ability to order lab work or imaging studies for what may seem a straightforward clinical case, can turn into hours of added work via the telephone, fax or email with payers insistent on limiting the amount of care delivered. These added services are NOT compensated financially and place excessive demands on physician time.
Added to this are the long hours, natural human stresses associated with dealing with ill or injured patients and their families, as well as the emotional toll of having to make major decision, often in a split second, and then being second guessed endlessly by peer review, insurers, or legal review.
Sadly, there is essentially nothing in the recently passed Affordable Care Act (ACA) which will be of much assistance to physicians. In fact the ACA will add multiple layers of additional burdens in terms of documentation, peer review, and patient volume expansion. Of even greater concern, is the fact that many of our most seasoned and experienced physicians and surgeons are looking for early exit opportunities in order to leave what they view as a declining practice environment.
Burnout and career satisfaction among American surgeons
Why do surgeons consider leaving practice?