Medical Care


Medical Education

Some Topics

Burnout

Burnout describes a collection of adverse responses to medical practice: emotional exhaustion, cynicism, detachment, and a sense of low personal accomplishment at work. Physician burnout is increasing. Nonclinical tasks can be time-consuming and frustrating for physicians who prefer to spend their time interacting with patients. For example, a recent survey of 1000 physicians by the American Medical Association revealed that prior authorizations consume an average of 16 hours of physician and staff time per week. Another study of outpatient practices revealed that for every hour of patient care, physicians spent 2 hours with the electronic medical record and administrative tasks.[4] Mandates to report "quality" data also result in hundreds of hours lost for patient care and cost billions of dollars.

US Physicians

In a recent survey, more than half of US physicians (55%) in multiple specialties report at least one symptom of professional burnout. The rate has reached a “tipping point.” Compared with a similar survey conducted in 2011, burnout increased by 10% in 3 years across all specialties. Satisfaction with work-life balance decreased over the 3 years as well, from 40.9% in 2014 vs 48.5% in 2011. Differences were seen by physician specialty, with the more physicians in family medicine, urology, and physical medicine and rehabilitation reporting symptoms of burnout. Burnout, inversely related to job satisfaction, occurs more frequently in physicians than other professionals. Longer hours, larger patient load, more nights on call, and increased clerical work were associated with burnout. Conversely, job autonomy, meaningful work, and support staff were associated with lower burnout risk.

Neurologists rank among the highest for burnout, even more so than pediatricians and family medicine physicians, two specialist groups burdened with clerical work, high patient loads, and relatively low compensation. Professional burnout among US physicians has reached a dangerous level, with more than half of physicians affected, according to the results of a 2014 national survey across various medical specialties and practice settings. Compared with responses from a similar survey in 2011, burnout and satisfaction with work–life balance have worsened dramatically, even though work hours have not increased overall. Dr Shanafelt from the Mayo Clinic's Department of Internal Medicine and colleagues published the survey results in the December issue of the Mayo Clinic Proceedings. They stress that interventions must address the organizational drivers of burnout in the practice environment, such as inefficiencies, the administrative burden, and inflexibility, and should not focus exclusively on self-help solutions, such as physician self-care or resilience training .The researchers invited 35,922 physicians to respond to their questionnaire. Of these, 6880 completed the survey between August 2104 and October 2014. The authors of the study compared the results with those from the 2011 survey and with those for a probability-based sample of working adults in the general population surveyed during the same period. Burnout rates, depressive symptoms, suicidal ideation in the last 12 months, and satisfaction with work–life balance were among the measured characteristics. evaluated with the Maslach Burnout Inventory, 54.4% of physicians reported at least one symptom of burnout in 2014 compared with 45.5% in 2011. Satisfaction with work–life balance also declined during the 3 years, to 40.9% vs 48.5% in 2011. Differences emerged by physician specialty, however: compared with 2011, burnout was higher in 2014 across all disciplines, with many climbing more than 10% in the 3-year interval. Dr Shanafelt noted that although students begin medical school with superior mental health profiles relative to graduates entering other fields, 1 or 2 years' medical study reverses this psychological situation, and once they begin to practice, "physicians have generally high degrees of satisfaction with their career choice but experience high degrees of burnout and dissatisfaction with work-life integration." (Shanafelt et al Burnout Affects Doctor and Patient. Mayo Clin Proc. 2015;90:1600-1613)

Hospital Residents

The adversities faced by hospital residents are numerous. The problems vary with the specialty and the institutions that train resident. Burnout is common. For example a study of pediatric residents at a prestigious teaching hospital reported on burnout:

Pediatric residents are not immune to the high levels of burnout experienced by their peers in other specialties, and their young patients may be paying the price.Of 258 pediatric interns and residents who responded to a Web-based survey designed to assess the trainees' levels of stress, burnout, relationship satisfaction, and work-life balance, 101 (39.1%) reported being burned out, defined as experiencing mental and physical exhaustion related to work or caregiving. Moreover, many of those who felt burned out indicated that the quality of the care they deliver has suffered as a result,  Baer, et al from Boston Children's Hospital reported in an article published online February 23 in Pediatrics. The results of the current burnout study — the largest to date within pediatrics, according to the authors — are consistent with the published literature and confirm that burnout is highly prevalent among pediatric residents. Addressing burnout is necessary to promote high quality, compassionate, and safe patient care, and educational leaders must address resident wellness to optimize the care we provide to our patients.


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