Like an engine with a bad wire that isn’t able to fire on all cylinders, physician burnout has the potential to drag down the performance of even the most committed and energized health care professionals. Consequences of burnout may ripple outward to include critical aspects of patient care. The Lancet, JAMA, the National Institutes of Health and the Mayo Clinic, among others have reported the importance of a work life balance, research important to both physicians and patients alike.
Cartoon credit to Rob Rogers, 2012, reprinted from The Chest Journal
What Is Physician Burnout?
Physicians, like people in other demanding professions, are susceptible to a state of mental or physical breakdown known as burnout. The result of prolonged stress, frustration or overwork, burnout is typically defined by three critical characteristics: depersonalization, low personal achievement, and emotional exhaustion.
The Causes of Physician Burnout
In a field characterized by long hours and life-or-death decisions, coupled with a culture that rarely encourages asking for help, it’s little wonder that physicians experience burnout. In fact, studies show that roughly 45 percent of practicing physicians demonstrate at least one symptom of burnout, and that burnout rates for medical students and residents may be as high as 50 percent and 76 percent, respectively.
Many factors contribute to the prevalence of physician burnout. Particularly notable in the earlier stages of a medical career, including the residency period, is the lack of work-life balance due to long hours, limited access to broader support systems, and lack of sleep. Perhaps surprising to non-physicians, inadequate pay can also contribute to a lower sense of well-being, especially if the physician has not pursued more lucrative specializations and medical school loans are looming large.
However, feeling overworked and underappreciated is commeon, even once a physician is well-established. Seeing too many patients, a rapidly changing medical landscape, an overabundance of paperwork, and the heavy burden of record keeping can lead to an emotional retreat, especially in more stressful treatment scenarios such as emergency rooms and surgical practices where the stakes are high but the opportunity to see long-term improvement is limited. The feeling of being merely a “cog in the wheel” can be further underscored if there isn’t a strong culture of teamwork and recognition in the workplace and when autonomy is restricted by government regulations, managed care systems and so on.
On top of high patient loads, physicians also need to be constantly working to stay educated on the latest treatments and drugs. Studying clinical journals, visiting medical websites and pursuing continuing medical education (CME) all contribute to the extreme workloads of many physicians and advanced practitioners.
How Physician Burnout Affects Patient Care
Research into the effects of burnout have shown that physician fatigue can be as incapacitating as a raised blood-alcohol level, leading to higher rates of error during surgery and when prescribing drugs. In addition, physicians experiencing severe burnout are less likely to recommend evidence-based screenings for their patients and are likewise less likely to proactively encourage healthy-lifestyle changes for patients (such as weight loss or smoking cessation). Their patients also generally experience lower satisfaction with their treatment and take longer to recover. The lack of connection with their physician may also explain why these patients also tend to show lower levels of compliance with prescribed treatments.
Physician burnout is a complicated problem with many contributing factors and equally complex impacts on patient care. Ultimately, patients will only receive the best possible care when their doctors are in a position that allows them to perform their best — mentally, emotionally and physically, making addressing physician burnout a top priority in the pursuit of quality patient care.
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