Few would argue that physician burnout is not a serious issue in the United States. As regulatory requirements, technological demands and administrative hassles have continued to chip away at physicians' time with patients -- with no end in sight -- levels of stress and frustration have mounted, in some cases boiling over into emotional exhaustion and even depression.
Unfortunately, family physicians have appeared to be especially prone to burnout. Research(www.medscape.com) has shown that the incidence of burnout among family physicians is as high as or higher than that in just about any other specialist. Left unaddressed, burnout can have negative effects on patients' access to care and the quality of care physicians provide, and may even adversely affect patient safety.(www.ahrq.gov)
The AAFP has responded by embarking on a wide-ranging series of efforts aimed at combating burnout and boosting the amount of time FPs can spend caring for patients by calling on national policymakers to slash administrative burdens and streamline regulations.
- Results of a survey of more than 5,900 U.S. physicians indicate that burnout prevalence for most specialties, including family medicine, decreased significantly from 2014 to 2017.
- The survey also showed that work-life balance satisfaction scores rose over the same period.
- Physicians still reported higher burnout prevalence and lower work-life satisfaction scores compared with the U.S. population at large.
To tackle burnout at the individual level, the AAFP created the Physician Health First portal that offers family physicians a banquet of well-being resources, as well as Transformation in Practice Series products that help them make substantive changes to their practices. And for those seeking an immersive experience where they can assess their risks for or causes of burnout and seek evidence-based wellness solutions, the annual Family Physician Health and Well-Being Conference can provide the tools they need.
New research suggests that the problem may be easing; a survey of more than 5,000 U.S. physicians(www.mayoclinicproceedings.org) published in Mayo Clinic Proceedings found that the prevalence of burnout decreased significantly from 2014 to 2017. The survey also found that physicians were more satisfied with their work-life balance in 2017 than they were in 2014. Yet despite these positive signs, physician burnout levels remained significantly higher than those in the general population.
Mirroring previous surveys conducted in 2011 and 2014, the researchers used a sample of physicians from all specialties obtained from the AMA Physician Masterfile. Of more than 30,000 physicians invited to participate, 5,197 completed surveys.
The main survey criteria were burnout and work-life balance. Burnout was measured using two domains from the Maslach Burnout Inventory(www.mindgarden.com) (MBI): emotional exhaustion and depersonalization. Physicians who scored high on either domain were considered to have at least one symptom of burnout.
To measure work-life balance, the researchers asked physicians whether they agreed or disagreed that their work schedule gave them enough time for their personal/family life. Physicians who responded "strongly agree" or "agree" were considered to be satisfied with their work-life balance.
Along with these measures, the researchers checked physicians for depression symptoms using the Primary Care Evaluation of Mental Disorders(jamanetwork.com) assessment tool. Physicians also provided standard demographic data, as well as information about their specialty, number of hours worked per week and practice setting.
To see how physicians stacked up with the U.S. population at large, the research team also surveyed a sample of adults using a tool called KnowledgePanel,(www.gfk.com) a probability-based panel designed to reflect the general population. All individuals surveyed via KnowledgePanel were employed and between the ages of 29 and 65.
Encouraging Signs for Family Physicians
Based on those partial MBI scores, 43.9 percent of all physicians in the survey reported at least one symptom of burnout in 2017, compared with 54.4 percent in 2014 and 45.8 percent in 2011. Notably, fewer physicians reported high depersonalization scores in 2017 than in the previous two survey years, and the percentage of physicians reporting a high emotional exhaustion score in 2017 (38.7 percent) was down nearly to the level seen in 2011 (37.9 percent).
On the downside, however, although fewer physicians overall reported symptoms of burnout, the percentage of those screening positive for depression increased slightly with each survey, from 38.2 percent in 2011 to more than 41 percent in 2017.
Still, the survey found encouraging news for family physicians. In 2017, 50.5 percent of family physicians experienced at least one burnout symptom. Although higher than the physician average, this figure still represented a 12.5 percent drop from 2014 and was nearly a full percentage point less than in 2011.
Regarding work-life balance, physicians overall were more satisfied with this criterion in 2017 than in 2014, but less satisfied than in 2011 -- a trend that also was seen among family physicians who completed the survey.
Comparison With the U.S. Population
The overall incidence of burnout among the general population was considerably lower than that for physicians and decreased slightly over the years, from 28.6 percent in 2011 to 28.1 percent in 2017. Conversely, work-life satisfaction scores were higher in the general population, starting at 55.1 percent in 2011 and increasing to 61.0 percent in 2017.
It's worth noting that physicians reported working an average 12.3 hours more per week than members of the general population, although even after controlling for this variable, physicians remained at higher risk for burnout, according to the researchers.
Reasons Behind Reductions
The researchers offered several possible explanations for their findings. One suggestion was that 2014 may have been a particularly difficult year because of hospital consolidations, new regulations and policies, and increased use of electronic health records, all of which may have led to a spike in administrative burden and resulting burnout. The authors speculated that physicians and organizations may have adapted to those changes over time, leading to the lower burnout rates in 2017.
Another suggestion was that some physicians who experienced burnout in 2014 may have left the workforce entirely or reduced their workload by 2017.
A third suggestion was that large-scale efforts "initiated at the national level to address this issue" by such entities as the National Academy of Medicine, Association of American Medical Colleges, Accreditation Council for Continuing Medical Education, AMA and others -- including physician specialty groups such as the AAFP -- may be making a real difference in how physicians feel.
"Even though (these efforts) are still in their early stages … people are talking about the problems, individuals recognize that they are not alone, and the visible leadership by influential national organizations and accrediting bodies … engaging regulators, payers, and other organizations may provide optimism for meaningful change," the authors wrote.
Despite the improvements, the researchers concluded that physician burnout remains a significant problem in the health care system. They characterized current efforts to improve physician well-being as being part of an ongoing journey and recommended that organizations coordinate their approach and focus on the underlying factors that lead to burnout to make real progress.
AAFP Physician Expert's Perspective
Clif Knight, M.D., AAFP senior vice president for education, told AAFP News the survey results are promising and should bolster the Academy's ongoing work to address the root causes of burnout.
"From the AAFP's perspective, the findings in this study are encouraging, but we can't let this diminish in any way the importance of continuing to seek solutions to the intolerable amount of unnecessary administrative burden that family physicians face every day," Knight said.
"We must continue to reduce documentation and reporting requirements," he added. "We must push back on corporate values that often place financial priorities above patient-centered priorities."
Addressing issues related to family physician burnout will remain at the forefront of the Academy's advocacy efforts, said Knight.
"The AAFP continues to demand that the value of primary care be more appropriately recognized and invested in," he noted. "The AAFP will continue to step up our efforts to systematically improve the well-being and professional satisfaction of family physicians.
"The noted improvement in family physician burnout rates is a good first step -- but we will accomplish much more."
Related AAFP News Coverage
Q&A With Clif Knight, M.D.
Physician Well-Being: Building on a Strong Foundation
Medscape: Why Family Medicine Burnout Is Different (and How Docs Fight Back)(www.medscape.com)