Physician burnout is a major issue affecting the quality and availability of healthcare in the US. The rising rate of this problem spurred a recent study aimed at identifying its roots. The study was published online in JAMA Network Open.
Physician burnout refers to “a state of emotional, physical, and mental exhaustion caused by prolonged stress in the workplace.” Multiple factors may lead to burnout, including lack of independence at the workplace, overwork, and lack of time for non-professional activities.
The importance of burnout in the medical field lies in the potential for errors in diagnosis and treatment, the lower patient satisfaction score, and the increased odds of absenteeism. It could lead to fewer physicians being available for healthcare, which may impact the neediest areas and the most in-demand specialties first.
This could cause patient waiting times for consults to go up, decreasing access to healthcare and reducing the quality of care as well.
The Maslach Burnout Inventory (MBI) was used to assess physician burnout. The MBI measures physician burnout using three subscales, namely, Exhaustion, Cynicism, and Professional Efficacy.
Surprisingly, over 45% of physicians reported one or more burnout symptoms using this scale. Some researchers reported a steep rise in burnout rates with the onset of the coronavirus disease 2019 (COVID-19) pandemic, especially as the second year ran its course.
The major features observed among physicians at this time were depersonalization and emotional exhaustion. Since many reasons may contribute to bias in the estimation of the national burnout rate among physicians, the current study sought to compensate for these factors and achieve a more accurate figure.
Some of these confounding factors include the fact that physicians with more experience tend to feel less burned out; those with more burnout tend to leave the medical field. Moreover, the response rate in burnout surveys is often low. The current study used a high-response survey, linking responses by participants through all three surveys to overcome sources of bias.
What did the study show?
The study comprised three surveys covering almost 1400 physicians belonging to the Massachusetts General Physicians Organization (MGPO). This number represents 73% of the number who originally enrolled in the first survey. The respondents belonged to either sex in equal proportions, but slightly over two-thirds were White. About 13% were Hispanic.
All three surveys had a high response rate, linked to the significant financial incentive of $850. While the first and second surveys in 2017 and 2019 obtained a 93% response rate each, the last one in 2021 had a 92% response.
The survey looked at four areas: career and compensation satisfaction, well-being, administrative workload, and leadership and diversity content. If two of the three MBI subscales showed a high score, burnout was determined to be present; otherwise, it was absent. However, a separate analysis also examined the measures in a continuous fashion.
Over the three surveys, more than one in four physicians were burned out, with no change observed in the state of burnout. Similarly, more than one in three physicians did not experience burnout at any stage.
In other words, more than 60% did not change their burnout score over the three surveys, but over 30% showed an increase in their already high scores.
Over a third of the physicians had been in practice for 11-20 years, reflecting considerable experience. In this group, the rate of burnout went down slightly from about 44% in 2017 to 42% in 2019. However, it then shot up to 50% in 2021. Compared to less experienced physicians, the odds of burnout in those in practice for 30 or more years were only a fifth of those with less than a decade of experience.
The whole cohort showed the same trend, with the burnout risk doubling in 2021, whereas it remained stable over the two previous surveys. Women in this field were at 50% higher risk for burnout than men. Again, those working in primary care were almost three times more likely to burn out than physicians in internal medicine.
The scientists also found that individual variation is major in determining burnout. During the same study period, for instance, over 60% of physicians reported exhaustion at the same level in all surveys, whether high or low. This was true for all three subscales.
Physicians with less burnout spent less time on non-physician (administrative) tasks, below a quarter of their time vs over 30% in the group with high burnout. They were more satisfied with their job and remuneration and had worked for more years. Perhaps it takes time to reach a level of practice where satisfaction outweighs the stress.
What are the implications?
The increasing burnout rate among US physicians is a cogent problem, given the rising rates of chronic health conditions requiring specialized and long-term healthcare. “This pattern represents a potential threat to the ability of the US health care system to care for patients and needs urgent solutions.”