Physician Burnout (Position Paper)

Introduction
The American Academy of Family Physicians (AAFP) is concerned about the high rates of professional burnout among physicians in the United States. This subject is of importance to the AAFP because primary care physicians suffer from significantly higher rates of burnout than physicians in other specialties.1 Burnout can negatively impact the quality of patient care and result in physicians leaving practice, thus contributing to the primary care workforce shortage.

The State of Physician Burnout
Physician burnout has been a significant area of concern and investigation for decades. A broad body of literature addresses both the causes of physician burnout and potential interventions to prevent or alleviate it. In addition, this issue has been covered in popular media.2,3 The literature shows that there is a high risk of physician burnout in the United States. A recent broad-based study reported that 45.8% of physicians are considered to be experiencing at least one symptom of burnout.4 The same study found that there is currently a 35.2% overall burnout rate among U.S. physicians. Further, the study found that physicians are almost twice as likely as the general U.S. population to report being dissatisfied with their work-life balance. These striking findings bear out across medical specialties, career phases, and demographics.5

Definition of Burnout
Definitions of burnout include the following:

  • “A syndrome characterized by a loss of enthusiasm for work (emotional exhaustion), feeling of cynicism (depersonalization), and a low sense of personal accomplishment.”6
  • “An emotional condition marked by tiredness, loss of interest, or frustration that interferes with job performance. Burnout is usually regarded as the result of prolonged stress.”7

Common Drivers of Burnout
The importance of identifying and addressing the root causes of physician burnout cannot be overemphasized. Despite much research, a lack of definitive data on causes of physician burnout still exists.8 Studies indicate that common drivers of family physician burnout include the following: paperwork; feeling undervalued; frustrations with referral networks; difficult patients; medicolegal issues; and challenges in finding work-life balance.9,10 These factors have varying impact at different stages of a physician’s career, with inability to resolve work-life conflict having the greatest impact for physicians early in their careers.11 Long hours, frequent call, frustration with administrative burden, and reimbursement issues strongly impact physicians in the middle of their careers.12

Effects of Burnout
There is growing understanding of how physician burnout directly affects patient health outcomes. New research shows that symptoms of physician burnout can be connected with increased rates of medical errors, riskier prescribing patterns, and lower patient adherence to chronic disease management plans.13,14 Middle-career physicians report long hours and frequent call, resulting in greater burnout and dissatisfaction among these physicians compared with physicians in other career stages and making them more likely to leave clinical practice.15 This is a notable concern because the middle of a physician’s career typically is the most productive phase in terms of providing patient care, serving as a leader and mentor, and assuming important administrative roles. The fact that burnout causes some physicians to leave practice early may explain why reported levels of satisfaction are highest among older physicians.

The U.S. health care system needs physicians to lead the transition to new methods of health care delivery and to sustain effective participation. However, almost half of U.S. physicians report symptoms of burnout, which compromises their ability to be effective in leading and sustaining change.16,17 Reducing physician burnout is critical to achieving the goals of redesigning the health care system and improving the health of patients, families, and communities in the United States.

Interventions to Reduce Burnout and Increase Satisfaction
Understanding the drivers of physician burnout informs the ongoing development of intervention models to prevent burnout and support services to help physicians cope with the symptoms. Historically, most programs to address burnout focused on the treatment of individual physicians (e.g., counseling services). Studies have found that self-awareness and mindfulness training can reduce physician burnout and increase both physician well-being and patient-centered qualities.18 There is a growing trend among health systems and other employers of physicians to adopt more system-level interventions, such as implementing institutional success metrics that include physician satisfaction and well-being, and developing practice models that preserve the decision-making autonomy of physicians.19

Conclusion
Burnout impacts physicians across all specialties. The AAFP believes that physician burnout is an important issue that must be dealt with openly and proactively because it affects both patient safety and physician well-being. In addition, burnout affects physicians’ decisions about remaining in clinical practice and their ability to lead changes at the practice and health care system levels.

Physician burnout is a system problem, not just an individual concern. The AAFP is committed to help individual family physicians learn personal resilience skills, as well as taking a systems-based approach to identifying and combating root causes of physician burnout.

References

  1. Leiter MP, Frank E, Matheson TJ. Demands, values, and burnout: relevance for physicians. Can Fam Physician. 2009;55(12):1224‐1225, 1225.e1‐6.
  2. Rabin RC, Kaiser Health News. A growing number of primary‐care doctors are burning out. How does this affect patients? Washington Post. March 31, 2014. http://www.washingtonpost.com/national/health‐science/a‐growingnumber‐
    of‐primary‐care‐doctors‐are‐burning‐out‐how‐does‐this‐affect‐patients/2014/03/31/2e8bce24‐a951‐11e3‐b61e‐8051b8b52d06_story.html.(www.washingtonpost.com) Accessed June 9, 2014.
  3. Pearl R. Malcolm Gladwell: Tell people what it's really like to be a doctor. Forbes. March 13, 2014. http://www.forbes.com/sites/robertpearl/2014/03/13/malcolm-gladwell-tell-people-what-its-really-like-to-be-a-doctor/(www.forbes.com).
    Accessed June 9, 2014.
  4. Shanafelt TD, Boone S, Tan L, et al. Burnout and satisfaction with work‐life balance among US physicians relative to the general US population. Arch Intern Med. 2012;172(18):1377‐1385.
  5. Leiter MP, Frank E, Matheson TJ. Demands, values, and burnout: relevance for physicians. Can Fam Physician. 2009;55(12):1224‐1225, 1225.e1‐6.
  6. Shanafelt TD, Boone S, Tan L, et al. Burnout and satisfaction with work‐life balance among US physicians relative to the general US population. Arch Intern Med. 2012;172(18):1377‐1385.
  7. Stress Reduction. Gale Encyclopedia of Medicine. 2008. http://medicaldictionary. thefreedictionary.com/Stress+Reduction(medicaldictionary. thefreedictionary.com). Accessed June 9, 2014.
  8. Gabbard GO. Medicine and its discontents. Mayo Clin Proc. 2013;88(12):1347‐1349.
  9. Lee FJ, Stewart M, Brown JB. Stress, burnout, and strategies for reducing them: what's the situation among Canadian family physicians? Can Fam Physician. 2008;54:234‐235.
  10. Dyrbye LN, Varkey P, Boone SL, Satele DV, Sloan JA, Shanafelt TD. Physician satisfaction and burnout at different career stages. Mayo Clin Proc. 2013;88(12):1358‐1367.
  11. Dyrbye LN, Varkey P, Boone SL, Satele DV, Sloan JA, Shanafelt TD. Physician satisfaction and burnout at different career stages. Mayo Clin Proc. 2013;88(12):1358‐1367.
  12. Dyrbye LN, Varkey P, Boone SL, Satele DV, Sloan JA, Shanafelt TD. Physician satisfaction and burnout at different career stages. Mayo Clin Proc. 2013;88(12):1358‐1367.
  13. Wallace JE, Lemaire JB, Ghali WA. Physician wellness: a missing quality indicator. Lancet. 2009;374(9702):1714‐1721.
  14. Shanafelt TD, Balch CM, Bechamps G, et al. Burnout and medical errors among American surgeons. Ann Surg. 2010;251(6):995‐1000.
  15. Dyrbye LN, Varkey P, Boone SL, Satele DV, Sloan JA, Shanafelt TD. Physician satisfaction and burnout at different career stages. Mayo Clin Proc. 2013;88(12):1358‐1367.
  16. Gabbard GO. Medicine and its discontents. Mayo Clin Proc. 2013;88(12):1347‐1349.
  17. Shanafelt TD, Balch CM, Bechamps G, et al. Burnout and medical errors among American surgeons. Ann Surg. 2010;251(6):995‐1000.
  18. Krasner MS, Epstein RM, Beckman H, et al. Association of an education program in mindful communication with burnout, empathy, and attitudes among primary care physicians. JAMA. 2009;302(12):1284‐1293.
  19. Dunn PM, Arnetz BB, Christensen JF, Homer L. Meeting the imperative to improve physician well‐being: assessment of an innovative program. J Gen Intern Med. 2007;22(11):1544‐52. Epub 2007 Sep 22.

(2014 COD)