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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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