Physician burnout: An Emerging National Epidemic

Results of two studies published in the latest issue of the JAMA have focussed on the syndrome of physician burnout and rates of career choice regret within the US medical establishment. While findings from one study showed that a high prevalence of symptoms of burnout was present with substantial variation with differing specialties, a systematic review found marked variation in the prevalence estimates of burnout among physicians and inconsistency in burnout definitions, thereby underscoring the dilemmas in the assessment of this fast-growing problem.

Burnout is a self-reported job-related syndrome increasingly recognized as a critical factor affecting physicians and their patients. Additionally, it is a known fact that medical errors and lapses in professionalism are a result of burnout among physicians. On one hand, a team of researchers at  Brigham and Women’s Hospital set out to make an accurate estimation of burnout prevalence among physicians along with characterization of methods used for the assessment of burnout. On the other hand, investigators from the Department of Medicine, Mayo Clinic, sought to evaluate whether the rates for symptoms of burnout among resident physicians varied with clinical specialty and if individual factors measured during Medical school related to the risk of burnout and career choice regret during residency.

Dyrbye and her colleagues conducted a prospective cohort study of 4732 US resident physicians, that followed doctors-in-training over 6 years. First-year medical students were enrolled between 2010 and 2011 and were asked to fill the baseline questionnaire. Subsequently, participants were invited to respond to 2 questionnaires; one during the final year of medical school (January-March 2014) and the other during the second year of residency (spring of 2016). The last follow-up was on July 31, 2016. The risk factors that were studied included the clinical specialty, demographic characteristics, educational debt, US Medical Licensing Examination Step 1 score, and reported levels of anxiety, empathy, and social support during medical school. The primary outcome comprised the prevalence during the second year of residency of reported symptoms of burnout. The doctors were asked to rate themselves on two statements: “I feel burned out from my work” and “I’ve become more callous toward people since I started this job.” Those questions were tailored to capture two of the three symptoms that fit the classical definition of burnout: exhaustion and feelings of depersonalization. A low sense of personal accomplishment was labeled as the third symptom. Furthermore, residents were also asked two questions designed to showcase regret on their career or subspecialty choice: “If you could revisit your career choice would you choose to become a physician again?” and “If you could revisit your specialty choice, would you choose the same specialty again?”

 

Results showed that among 4696 resident physicians, 76.4% completed the questionnaire during the second year of residency (median age, 29 [interquartile range, 28.0-31.0] years in 2016; 50.9% of them being women. Nearly half (45.2% ) of junior physicians were already having burnout symptoms at least one day a week. (95%CI, 43.6%to 46.8%). A large number(14.1%) of resident physicians felt regretful of their subspecialty choice. (95%CI, 12.9% to 15.2%, 1.24 to 1.48) Risk factors associated with higher symptoms of burnout included female sex (RR, 1.17 [95%CI, 1.07 to 1.28] and higher reported levels of anxiety during medical school (RR, 1.08 per 1-point increase [95%CI, 1.06 to 1.11]; RD, 1.8%per 1-point increase [95%CI,1.6%to 2.0%]). A higher reported level of empathy during medical school was associated with a lower risk of reported symptoms of burnout during residency (RR, 0.99 per 1-point increase [95%CI, 0.99 to 0.99]; RD, −0.5%per 1-point increase [95%CI, −0.6%to −0.3%]). Reported symptoms of burnout (RR, 3.20 [95%CI, 2.58 to 3.82]; RD, 15.0% [95%CI, 12.8% to 17.3%]) and clinical specialty (range of RRs, 1.66 to 2.60) were both significantly associated with career choice regret.

However, the results of the study conducted by Rotenstein and his colleagues at BWH showing huge variations in definitions of burnout and estimated rates among doctors, ranging from 0 to 80 percent highlighted the importance of developing a consensus definition of burnout and of standardizing measurement tools to evaluate the effects of chronic occupational stress on physicians. After gathering 182 reports involving 109,628 physicians from 45 countries, they determined that the definitions of burnout and the study methods were so disparate that it was impossible to draw any conclusions. Moreover, lack of a clear distinction between burnout and depression may also pose to be a major problem.

Scrutinizing the results of the two studies, Katherine J. Gold, associate professor of family medicine and obstetrics and gynecology at the University of Michigan and co-author of an editorial in JAMA commented, “If a construct like burnout is so variable in its prevalence, then either its measures are highly unreliable, or seemingly similar populations differ widely in risk. Both explanations are worthy of study. Simply accepting the oft-quoted statement that “half of all physicians are burned out” is inappropriate. If the risk of burnout varies widely according to location, clinical setting, type of practice, medical specialty, and other demographic features, an explanatory model is essential to the understanding of the specific components of these demographic correlates that could lead to interventions.”

Highlighting the importance of these studies, Dr. Albert W. Wu, an internist and professor of health policy & management at the Johns Hopkins Bloomberg School of Public Health in Baltimore, Maryland, stated,“With two lead articles in one of the most prominent medical journals in the world, it means that burnout is now being taken seriously by the medical mainstream. Burnout is being endorsed at an alarming rate by physicians who range from trainees to seasoned veterans and it is accompanied by other disturbing correlates that include a high rate of suicidal ideation, regret about one’s job choice and an acknowledgment of not being one’s best self in practicing medicine.” Emphasizing the seriousness of the matter, he added, “This represents a crisis in slow motion.”