Addressing Physician Burnout: Causes, Symptoms and Treatments
Physician burnout is an increasingly prevalent syndrome that has been described as “a public health crisis that urgently demands action.” According to research published in the Journal of the American Medical Association, burnout impacts approximately two-thirds of physicians and is characterized by emotional exhaustion, depersonalization – which manifests as irritability and detachment – and a lack of sense of personal accomplishment. The World Health Organization describes it as a widespread and damaging occupational phenomenon resulting from long-term job-related stress. This stress can stem from long work hours, lack of appropriate work-life balance, administrative burden, and emotional depletion, all of which can be common in physician training and practice.
Burnout significantly impacts the quality of care provided to patients and can cause costly medical errors. It also leads to diminished retention and increased physician migration, both of which prove pricey for health care facilities and cause workload transfer that can accelerate burnout in other physicians.
In order for medical professionals and their workplaces to mitigate the risk and impact of burnout, it is important to understand its causes, symptoms, and treatments. While there are several variables that can cause or worsen burnout, lifestyle is the primary problem: physicians typically have packed schedules with little time for friends or family, and the increasing prevalence of administrative duties can mean that physicians spend more time on documentation and clerical work than interacting with patients. Therefore, improving work-life balance is a key factor in addressing physician burnout.
Although physicians have anecdotally reported mitigating burnout symptoms by participating in self-care activities such as journaling, exercise, and communication with peers, research overwhelmingly indicates that burnout is the symptom of a deeper problem within the structure of healthcare. Solutions for improving physician well-being can include steps like reducing the stigma surrounding mental health, providing stress management training, and adjusting work hours and diversity of tasks. However, this requires long-term investment and systematic change. Thus, many physicians find that they need to take burnout into their own hands and address their exhaustion by changing their self-care practices and making substantial changes to their careers in medicine.
An increasingly appealing option for physicians seeking to minimize burnout and reduce unpredictability in their work lives is by pursuing alternate career paths. This could include healthcare consulting, telemedicine, or medical device development, among other things. Changing career paths may be particularly appealing as the health care industry faces layoffs. For physicians seeking a career change involving autonomy, clinical satisfaction, increased patient engagement, and work-life balance, wound care is an excellent option.
At Vohra Wound Physicians, the nation’s most trusted wound care group, physicians have competitive pay, flexible and consistent schedules, and meaningful patient interactions. Vohra provides care in nursing homes, assisted living facilities, and skilled nursing facilities, and via telemedicine and has over one million patient encounters per year. Vohra physicians report career gratification, satisfaction working with the company’s physician-designed Electronic Medical Record (EMR), and an excellent work-life balance.
Physicians considering a career in wound care are invited to apply for a position at Vohra.
Physician Burnout Overview
What is causing physician burnout?
Physician burnout is primarily due to professional stress coupled with a lack of work-life balance. Although burnout can be experienced in any profession, it primarily affects those doing “people-work,” with two well-known examples being medicine and human services. Physicians in particular have to undergo difficult and lengthy training in order to enter the field, and once they begin practicing, they are continuously assessed and placed in high-stress or emergency situations.
Physicians frequently interact with people who are experiencing significant physical or psychological distress. This can lead to emotional exhaustion, a key aspect of burnout. Medical care can also involve a fair amount of uncertainty, which can cause frustration or self-blame; treatment solutions are not always clear and patient outcomes are not always desirable, regardless of physician behavior.
Physician lifestyle is another crucial factor in burnout. Long hours spent at work can impact work-life balance and negatively affect relationships with family and friends. There is also often stigma associated with seeking help for mental health disruptions, which can be detrimental to physician well-being. This can prevent physicians from reaching out and can cause burnout to worsen.
Is physician burnout increasing?
Physicians consistently remain at increased risk for burnout as compared to workers in other professions due to their lifestyles and work-life balance. Over the past decade, physician burnout rates have hovered around 50% with minimal fluctuations. While burnout rates remain consistent, rates within subgroups of physicians, such as specialty or generation, may differ.
Within the past five years, physicians specializing in critical care, emergency medicine, neurology, and urology, among others, have experienced the highest rates of burnout. According to Medscape’s National Physician Burnout & Suicide Report 2020, physicians in Generation X currently report the highest rates, likely due to responsibilities that they must manage outside of work, such as caring for children or aging parents. Female physicians consistently report higher rates of burnout than male physicians; in 2019, 48% of women reported burnout as compared to 37% of men. It seems that physician burnout, on the whole, will remain fairly consistent unless changes are made to the healthcare system, though many physicians are becoming increasingly aware of the opportunity to transition to a more autonomous, less stressful medical specialty like wound care.
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How is physician burnout measured?
Physician burnout is measured using well-being assessment tools that gauge factors such as emotional exhaustion, professional satisfaction, and engagement levels. Some organizations develop their own wellness surveys based on specific research or needs, but commonly used assessments include the Maslach Burnout Inventory, the Stanford Physician Wellness Survey, and the Physician Well-Being Index. These tools determine burnout by assessing indicators of work-related stress, such as professional fulfillment, personal resilience, and level of compassion. Regardless of the tool used, it is important that burnout assessments are standardized, routine, and compared to benchmark data, particularly since physicians are not always able to accurately assess their own burnout.
Is burnout a medical condition?
Burnout is not considered a medical condition. However, the International Classification of Diseases (ICD-11), the global standard for health assessment, categorizes burnout as a “syndrome resulting from chronic workplace stress.” It further breaks down the phenomenon into three key characteristics: exhaustion, mental detachment, and diminished professional efficiency. Although burnout itself is not considered a medical condition, it’s important to note that if left untreated, burnout can lead to anxiety, depression, and/or other related mental health disorders. Overall, burnout impacts physician mental health and career satisfaction as well as patient quality of care, making it a phenomenon in need of serious attention and amelioration in medical practice.
What are the impacts of medical burnout?
Medical burnout has a significant impact on physicians, their patients, and the health care institution in which they operate. Burnout causes professional dissatisfaction and emotional exhaustion that hinders effective patient care. Physicians experiencing burnout take longer to perform surgical operations, are slower to read ECGs, and experience delayed math and science skills. It also leads to a significant increase in medical errors, which can lead to patient frustration or costly lawsuits, or reputation damage. Burnout is also a key reason that physicians leave their positions or the medical field on the whole. Physician turnover can cost institutions $500K-1M in revenue and add thousands to recruit replacements. Physician loss also impacts the continuity of patient care and can cause other physicians to become overwhelmed with new cases, which perpetuates further burnout.
Physician burnout can lead to other mental health disruptions such as depression and anxiety and can lead to substance abuse disorders. It has also been cited as a factor in physician suicide, which has an occurrence rate of over twice that of the general population. When physicians experience impacted mental health, it is damaging to their quality of life as well as to that of their friends, family, and patients.
Physicians suffering from burnout that decide to transition to wound care with Vohra appreciate autonomy, career gratification, competitive pay, work-life balance and never taking calls.
Maslach Burnout Inventory
What is the Maslach Burnout Inventory?
The Maslach Burnout Inventory (MBI) is the “gold standard” of burnout assessment tools and is widely used in the field of health care to determine medical student, nurse, and physician burnout. It assesses burnout by classifying emotional exhaustion, depersonalization, personal accomplishment, and, in some MBI surveys, cynicism and professional efficacy. The MBI was developed in 1981 and has proven successful across a wide range of occupations and geographic locations. It has been continuously updated since its creation and now comprises five separate versions designed to accommodate varying needs. These forms are as follows:
- Human Services Survey (MBI-HSS)
- Human Services Survey for Medical Personnel (MBI-HSS (MP))
- Educators Survey (MBI-ES)
- General Survey (MBI-GS)
- General Survey for Students (MBI-GS (S))
These five versions are of varying lengths and take approximately 10-15 minutes to complete. The MBI-HSS is the most prevalent version of the MBI, and the MBI-HSS and MBI-HSS (MP) are those most frequently utilized to assess physician burnout. The HSS versions each comprise 22 items and are the same except for updated language; the MBI-HSS (MP) refers to “patients” rather than “recipients.”
Who created the Maslach Burnout Inventory?
The MBI was created by Christina Maslach, Ph.D., an occupational burnout specialist. Maslach, a graduate of Harvard-Radcliffe College and Stanford University, is a social psychologist and a Professor Emerita of psychology at the University of California Berkeley. She is well-known for her work researching occupational burnout and has authored numerous papers and books on the subject. Maslach has won myriad awards for her contribution to psychological science and she is a fellow of the American Association of the Advancement of Science, the American Psychological Association, and the Western Psychological Association.
What does the Maslach Burnout Inventory measure?
The MBI assessment forms used in healthcare measure burnout by classifying its component factors: emotional exhaustion, depersonalization, and personal accomplishment. This is done by presenting respondents with a number of questions or statements about their daily emotional states and requiring them to indicate the frequency and strength of experience. For example, an item assessing emotional exhaustion states, “I feel emotionally drained from my work.” Respondents can then indicate how frequently they feel this way by selecting one of the seven options presented, ranging from “never” to “every day.”
The emotional exhaustion questions seek to identify whether respondents are experiencing fatigue, emotional distress, or depletion of energy. The depersonalization scale addresses instances of indifference in professional behavior, which is particularly important in healthcare. For example, one prompt states, “I don’t really care what happens to some patients.” The personal accomplishment scale indicates respondent confidence in their professional behavior and positive impact on their work environment. For example, “I have accomplished worthwhile things in my job.”
How do you score the Maslach Burnout Inventory?
The MBI is scored on a scale from 0-6. Each question has six response options denoting a different frequency of experience, and each option is assigned a number from one to six, starting with “never” at zero and scaling up to end with “every day” at six. Final results provide respondents with an averaged numerical answer for three criteria: level of emotional exhaustion, depersonalization, and personal accomplishment. High levels of emotional exhaustion and depersonalization combined with low levels of personal accomplishment are indicative of burnout.
How is the Maslach Burnout Inventory used?
The MBI is employed to assess burnout in a variety of sectors, including educational institutes and government establishments. The results of the MBI are intended to indicate instances of burnout such that organizations can seek to address its causes and outcomes. In healthcare settings, the MBI has indicated that physician burnout and nurse burnout are significant and necessitate addressing. Institutions that implement the MBI can look at average scale scores for their employees in order to inform organizational decisions and mitigate the negative impacts of burnout. Individual scores can also be broken down and contextualized by percentile within an organization such that outliers can be identified. Institutions can also receive recommendations based on the score reports of their employees.
Burnout during Medical Residency Programs
Research increasingly indicates that the symptoms of burnout in health care workers take root early in medical training, appearing in pre-medical undergraduate students and persisting through medical school and post-graduate education. Once students graduate from medical school, they are technically qualified physicians but the majority then complete residency programs, which is further training that lasts for 3-7 years, depending on specialty. Doctors pursuing residency programs are often considered ‘doctors in training,’ as they not only complete patient care but must become experts in the area in medicine they hope to pursue. This involves significant professional commitment as well as continuous studying and preparation outside of work hours. As a result, approximately 45% of medical residents exhibit symptoms of burnout.
What is causing resident burnout?
Residency can be a time of extreme stress. In America, residents work approximately 80 hours per week, have 24+ hour shifts several times per month, and spend significant free time studying and further preparing themselves for professional success. This lifestyle can prevent appropriate work-life balance and impact social relationships. Residency can also cause significant financial strain. Residents earn a fixed, modest salary that often equates with what is paid to the hospital cleaning staff by the hour. This makes it difficult to afford regular expenses and pay off educational debts and can feed into a sense of professional dissatisfaction. These professional demands cause residents to experience emotional exhaustion, burnout, and career regret.
Can stress management intervention prevent resident burnout?
Although some of the lifestyle factors that lead to burnout are difficult to control, physician mindset and response to these stressors can mitigate burnout. Research has indicated that emotional intelligence (EI) training can counteract the impact of burnout in residents, leading to “immunity” from burnout. Educational training using the EI model trains residents on the importance of self-awareness, self-management, social awareness, and social skills. This aids in emotional understanding and response to unchangeable situations, which in turn improves wellness and diminishes instances of burnout in residents.
On a more individual basis, residents can mitigate burnout risk by increasing self-care practices such as extracurricular activities, regular exercise, and mental health support. Residents may also decide to forgo residency and/or seek alternate medical career paths that enable better work-life balance. Additionally, some physicians may seek careers that do not require complete residencies, such as wound care, where jobs often only require two years of residency.
Physicians interested in learning more about how an autonomous career in wound care leads to clinical satisfaction, work-life balance, and competitive pay are invited to apply for a position with Vohra.
How can attendings affect resident burnout?
As doctors complete medical residencies, they are overseen and mentored by attending physicians that provide educational advice, career guidance, and performance feedback. Residents experience significantly more burnout than attendings across multiple specialties. Attendings can mitigate resident burnout by supplying regular, constructive praise and criticism and building supportive relationships with residents. This improves feelings of competence and professional satisfaction and can help attendings recognize when resident physicians are struggling with symptoms. Attendings demonstrating investment in resident success and interest in their personal experiences can also foster a sense of community and organizational support.
Which physicians experience burnout?
Physician burnout often begins in pre-medical undergraduate studies and persists through graduate and post-graduate medical training to span every specialty. Despite the widespread nature of burnout, risk factors impact its frequency and severity, such as preexisting mental health conditions and medical specialty. Physician burnout is often comorbid with other conditions such as anxiety, depression, and substance abuse; the presence of these disorders can increase the likelihood and severity of burnout. Burnout prevalence also differs among specialties, in part due to the differences in the number of hours worked per week, as well as between physician age and gender.
What does physician burnout look like?
Physician burnout is primarily seen as emotional disruption and feelings of failure that lead to subsequent performance errors and even reduced quality of care. In most cases, burnout presents as continuous fatigue, frustration, cynicism, and detachment, both at work and at home. For many, it impacts the quality of sleep, which in turn damages language and math skills, emotional resilience, surgical procedure length and quality, and ECG interpretation. This can be costly for physicians, their patients, and their institution.
How can doctors prevent burnout?
The consensus among medical professionals seems to be that truly eradicating burnout necessitates significant organizational change within the healthcare system. This involves altering stressors such as schedule structures, task distribution, and methods of record-keeping, as well as implementing wellness programs and providing readily available, stigma-free mental health resources.
On an individual basis, physicians can prevent burnout by encouraging this systematic change while also seeking to manage their own symptoms. Individual symptom management can involve improving diet and exercise habits, prioritizing time with friends and family, and seeking help when symptoms arise. Within a professional setting, physicians can also seek to optimize EHR practices and delegate tasks in order to spend more time seeing patients. Alternatively, physicians may seek to alter their career paths in order to prevent burnout, such as by transitioning to a specialty like a wound care with a more regular schedule and greater autonomy.
How to address physician burnout?
Physician burnout is a public health crisis that currently does not show signs of improvement. It affects physicians at all levels of education and within all specialties and leads to errors that can be financially and reputationally costly to both physicians and their institutions. Burnout has become especially visible during the COVID-19 pandemic, as physicians work longer hours, suffer from equipment shortages, and risk their lives each day.
It is critical that burnout is better identified and addressed, and since many changes need to be instituted within healthcare as a whole, physicians must take much of the problem into their own hands. This can involve seeking therapy and/or mentorship, making career adjustments, pushing for organizational change, and aiming for increased face-to-face time with patients.
One study also showed a significant improvement in physician burnout scores after quality improvement initiatives. These enhancements were implemented in the most burdensome areas for doctors, such as medication reconciliation, entering patient data into the EMR, etc. After implementing the initiatives, these tasks were delegated to non-physician staff, resulting in increased physician satisfaction and decreased stress.
According to the American College of Physicians, culture change interventions like limiting work hours can reduce burnout and improve physician well-being. Some examples of culture change include flexible work hours, investing in executive leadership, and proactively working to reduce the stigma associated with mental illness to encourage physicians to seek help when they need it. It is also recommended to create Wellness Committees in healthcare facilities. As opposed to preventing burnout, a Wellness Committee focuses on promoting the wellness of doctors through cultural changes in the way the medical fraternity works.
Can you be diagnosed with burnout?
Since it is not classified as a medical condition, you cannot be diagnosed with burnout. However, it is defined in the ICD as a syndrome with a characteristic set of symptoms, so it can be listed as a reason for seeking mental care and/or as a factor contributing to other conditions, such as anxiety.
How can burnout be addressed?
Once a physician is experiencing burnout, there are several strategies that they may employ to improve their experiences:
- Remember your mission. A common reason for entering health care is a desire to help people and to identify and address problems. Remembering this goal can aid in mitigating the frustration of being tasked with bureaucratic or administrative tasks.
- Build resilience. Placing a meaningful focus on building emotional and mental strength is extremely effective in preventing or mitigating burnout. Resilience practices can include meditation, yoga, support groups, or therapy.
- Practice self-care and gratitude. Maintaining a healthy diet and exercise routine is critical for positive mental health. Other practices, such as regularly calling loved ones to check in, are also valuable. Focusing on reasons to be grateful has also been shown to improve negative self-talk.
- Seek organizational change, or seek a new organization or path. Encouraging your institution to institute better wellness practices and to mitigate the causes of burnout is an important step for addressing burnout. However, these changes can be slow-moving. If physicians are seeking immediate change, it is often preferable to seek a place of work that addresses the causes of their burnout symptoms, such as one that provides better work-life balance. Wound healing contributes to mental health, has more consistent scheduling and work-life balance, and is associated with job satisfaction. Apply now for a position with Vohra.
- Investing in automating health systems can help reduce burnout. According to a study of primary care physicians, electronic health records (EHR) are responsible to a large extent for job stress and physician burnout. The study reveals that medical interns spend only 12% of their time on direct patient care compared to 40% on computer use. Unsurprisingly, clinicians rank excessive data entry as a top challenge followed by difficulties in accessing data from other institutions. Improving the level of training for computer use and information technology and automating patient records can thus improve physician well-being to a great extent.
How should burnout be addressed moving forward?
In order to significantly decrease burnout rates, health care systems must become increasingly attentive and committed to burnout causes and symptoms in their institutions. This involves physician well-being assessments, emotional intelligence training, and readily available mental health resources without associated stigma. As this progress continues, physicians can work to mitigate their risks of burnout by making individual changes in their personal or professional lives, such as prioritizing self-care or shifting career paths.
One such career change is specializing in wound care at Vohra Wound Physicians. Vohra offers one of the only wound fellowships in the world and enables physicians to have meaningful patient interactions while maintaining a work-life balance and earning a competitive salary. A career change to wound care at Vohra allows physicians to focus on what they love about medicine without risking burnout.