Physician burnout improves, but more work ahead

Physician burnout is getting better, according to a new triennial study published in Mayo Clinic Proceedings. In fact, doctors were less likely to indicate emotional exhaustion and depersonalization in 2017 compared to 2014, and burnout prevalence is closer to 2011 levels.

In 2017, 43.9 percent of U.S. physicians exhibited at least one symptom of burnout, according to the study, which was conducted by Mayo Clinic and Stanford University School of Medicine. That’s a big drop from the 54.4. percent of physicians that reported the same in 2014, and below the 45.5 percent reported in 2011.

“This trend is encouraging and suggests improvement is possible despite the numerous contributing factors and complexity of the problem,” lead author Tait D. Shanafelt, MD, of the department of internal medicine at Stanford University Medical Center, et al. wrote.

Still, the issue remains serious, as the healthcare industry faces a looming doctor shortage, particularly in certain areas of the nation. Physicians have much higher rates of burnout symptoms than the overall U.S. workforce, which had burnout prevalence of 28.1 percent in 2017.

Many major healthcare institutions have made professional burnout a top area of improvement, and other efforts are underway to find the underlying causes. Burnout also has significant dangers, including feelings of depression and suicide, along with the potential for more medical mistakes, and even patient death.

“Although the improvement is good news, symptoms of burnout remain a pervasive problem, and its prevalence among physicians continues to be markedly higher than in the general U.S. working population, even after adjustment for differences in hours worked, age, sex and relationship status,” Shanafelt and colleagues wrote.

The American Medical Association agrees that more needs to be done to improve the issue.

“The tide has not yet turned on the physician burnout crisis,” AMA President Barbara L. McAneny, MD, said in a statement. “Despite improvements in the last three years, burnout levels remain much higher among physicians than other U.S. workers, a gap inflamed as the bureaucracy of modern medicine interferes with patient care and inflicts a toll on the well-being of physicians.”

Burnout causes and improvements

Researchers surveyed more than 5,000 U.S. physicians between October 2017 and March 2018. Burnout was measured using the Maslach Burnout Inventory (MBI) scales of emotional exhaustion and depersonalization. A high score on the MBI scales indicated having at least one manifestation of professional burnout.

Electronic health records (EHRs) have been pinpointed as a top cause of burnout, with physicians spending up to half of their workday plus 28 additional hours on nights and weekends on EHR tasks. The EHR demands, along with other administrative efficiency measures, productivity metrics and imperfect patient satisfaction measures, have changed what it means to be a good doctor in many organizations, the researchers noted.

There are also several possible explanations as to why physician burnout decreased from 2014. For example, some physicians may have simply left the workforce due to burnout over the last few years, or they might have adapted better to the new practice environment. Or, 2014 may have just been a particularly challenging year, with new regulations, increasing EHR penetration and higher administrative burdens, researchers observed.

Other efforts to improve burnout may also be working––more recognition about the issue, coupled with leadership acknowledgement across the industry, has led to higher engagement to combat the problem. The efforts should be ongoing among both individuals and organizations, researchers noted. Still, the modest improvement in burnout levels from 2014 to 2017 should leave room for optimism.

“The progress demonstrated in today’s research suggests that growing national efforts to address physician burnout are on the right track, but more work is needed to achieve meaningful change,” McAneny said. “Addressing the crisis requires continued investment from the health system in a comprehensive strategy that targets barriers to efficiently providing patients with high-quality care as the primary driver of physician burnout.”