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Mayo clinic study shows physician burnout at new Fahrenheit

The coals of occupational burnout have left few unscathed. Pillars of labor, marred by the soot of a faltering economy, sag under the weight of a leaden national morale as the workforce continues to ebb and stall haphazardly. And now, according to a recent Mayo Clinic study, even physicians — champions of hope atop the healthcare mast — are wavering in the heat.

Nearly half of the 7,288 physician participants (45.8 percent) exhibited at least one symptom of burnout, the Mayo study found. Specifics draw the line darker still — 37.9 percent of doctors cited extreme emotional exhaustion, while 29.4 percent reported experiencing a sense of “high depersonalization,” which is, according to the Mayo Clinic, the sensation of watching oneself from afar, significantly displaced from present reality and self.

Analysts posit that this physician Fahrenheit 45.8 won’t be cooling off anytime soon, either.

"The rates are higher than expected," lead author of the Mayo study Tait Shanafelt, MD, told USA Today. "We expected maybe 1 out of 3. Before healthcare reform takes hold, it's a concern that those docs are already operating at the margins."   

When contrasted with survey responses from 3,442 non-physician working adults in the United States, 37.9 percent of doctors signaled burnout whereas only 27.8 percent of non-physicians reported the same singe. Moreover, 40.2 percent of doctors reported being disenchanted with their work-life balance compared to the 23.2 percent reiterating similar dissatisfaction in the non-doc control group. Study authors labeled such results as alarming, but other correspondents familiar with healthcare’s heat were far from astonished.

“Does it surprise me that a good proportion of physicians experience some form of elevated stress?" Terrance Bedient, vice president of the Medical Society of the State of New York, in Albany, opined for HealthDay News. "No, it does not. Everyone is subject to the stresses of personal issues and social concerns related to the family. But physicians also labor under particularly high expectations and demands, increasingly limited independence, and a dropping rate of compensation, historically speaking, for their work."

Researchers found that the heightened demand drive for doctors initially sparks on the degree path — those who possessed an MD or a DO degree were more likely to experience burnout than other college degrees, the study noted. From graduation day onward, depending on specialty, a doctor’s road to practice success can be riddled with several more burnout detours along the way.

"There have been other studies done on doctor burnout, but we assumed it was the surgical specialties who would be at primary risk," Shanafelt said. "Instead we found out it's the physicians on the front line of care who are at the greatest risk."

The highest rates for burnout among specialties were discovered in emergency medicine, general internal medicine, neurology and family medicine. Pathology, dermatology, general pediatrics and preventive medicine displayed the lowest burnout rates.

The consequences of burnout can be fairly devastating: Quality of care can face a serious downturn as medical errors and early retirement go on the upswing.

"This is relevant to patients and doctors alike, because physician burnout and dissatisfaction have been linked to poorer patient outcomes, medical errors, patient dissatisfaction and serious physician issues such as suicidality," co-author Colin West, MD, at the Mayo Clinic's divisions of general internal medicine and biomedical statistics, told HealthDay News. "Also, with healthcare reform and anticipated increased demand for front-line care providers, the severity of distress among these physicians is particularly concerning."

Bedient spoke of resources available to physicians to assuage burnout and thus, keep them practicing longer, happier.

"State medical and physician support programs, which are already in place in every state in the country, have been extraordinarily successful in helping doctors with this and other kinds of stress-related problems," Bedient said. "The difficulty is that physicians, like people in general, often have trouble figuring out where to turn for help. So we really have some work to do to encourage physicians to look at their own stresses, figure out what kind of help they need, and to feel comfortable reaching out for that help when they need to."

Other studies conducted on behalf of physician burnout further the need for lawmakers to produce solutions quickly. A report from Physician Wellness Services and Cejka Search showed that of the 2,000 doctors surveyed, 87 percent experienced stress and burnout on a daily basis. An earlier national report by physician Mark Linzer, MD, director of the Hennepin Healthcare System in Minneapolis, found that 26.5 percent of doctors mentioned burnout, citing more than one symptom.

"The Affordable Care Act is going to put more pressure on the front lines,” Linzer told USA Today. “This new study could be an important wake-up call the country needs to hear to build healthcare teams to meet the need."

Coordination on the provider frontlines, Linzer added, is key to easing the burn in the meantime.

"It used to be all about the clinician caring for the patient. Now it needs to be the clinician, nurse, care coordinator and others. When you start expanding the numbers of types of people who are caring for a patient, that helps a doctor and patient a lot."

For the sake of physicians and patients, Mayo and other medical experts alike hope this fire won’t reign in the years to come. 

“The fact that almost 1 in 2 U.S. physicians has symptoms of burnout implies that the origins of this problem are rooted in the environment and care delivery system rather than in the personal characteristics of a few susceptible individuals. Policy makers and health care organizations must address the problem of physician burnout for the sake of physicians and their patients," the current Mayo team concluded in their report commentary.

The study was published in the journal Archives of Internal Medicine.

Photo attributed to Menchi via Creative Commons license.

Comments (3)

Richard E. Sacks-Wilner, MD: Actually it's already too late - I know it, you know it & the powers-that-be know it; Primary Care is DEAD at the hands of the insurance monopoly & Medicare. The pipeline is nearly empty at a time when demand will skyrocket and it appears that the (possibly unintended, but I think quite purposeful) scheme is to turn it over to FNP's and PA's. Which will, of course, result in significantly poorer care particularly for the complicated, elderly patients that Internal Medicine Docs were intended to treat, more tests/MRI's, more unnecessary consults and thus more frequent & longer hospitalizations resulting in a FALSE cost savings overall (we won't bother to mention deaths)...But Medicare Part-A comes out of a different "pot" than Medicare Part-B; so they don't talk to each other or care about the others expenses. I'm very concerned about organized medicines push toward the "Medical Home" as many recent articles have shown the costs of P4P (Pay 4 Performance - really Pay 4 Paperwork) are prohibitive, particularly in the rural, 1-3 Doctor offices which need salvaging RIGHT NOW. The AMA & the ACP should be leading the charge & the NEJM/Professional Journals/Societies should be rallying a call to arms, not a tepid "discussion". They're not, because the AMA has written off Primary Care - if you don't think so, just look at all they've done to & for Primary care - or better yet look at how little they've done and/or backed that BENEFITED Primary Care. The ridiculously skewed RVRBS/RVSUC that ruinously devalued Primary Care services (while overvaluing surgical services) is a child of the AMA. The reviled CPT coding books; more progeny of the AMA. After 21 years of Practice I can say it's not added up to enough to keep me and ALL of my colleagues who practice medicine as it SHOULD be practiced, in business. You can argue all you want about that, but those ARE the FACTS. I'm glad that other specialties/subspecialties had significantly greater margins, so they can tolerate the yearly pay cuts in the form of insufficient increases to match inflation/expenses; but that's never been true of Primary Care, and the AMA never has & never will advocate a boost to Primary Care that will cost these same specialties/subspecialties that can afford to continue paying dues. A familiar ritual is underway in Washington again: an over 20% Medicare pay cut was set to take effect on January 1st , 2012. This is required by a Byzantine formula that congress came up with over a decade ago and the cuts which started out relatively modest have ballooned to over 20%. But lawmakers once again postponed the cut - though this time by only two months & again this year. Honestly, I wish the threatened January 2008 - 10.6% pay cut and now the over 21% pay cut scheduled for February 2011 would go forward. Imagine trying to run a business with a 10% margin when threatened pay cuts involving over 50% of your clients occurs on a nearly yearly (and lately more frequent) basis. These cuts will render many if not all Primary Care practices insolvent, forcing many to drop Medicare & Blue (double) Cross etc. I firmly believe that this is the ONLY way Primary Care Practices can survive and render proper care. Yes, the Ophthalmologists, Dematologists, Radiologists, Cosmetic Surgeons etc etc can still tolerate far more than 10% for their practices to fail, but that's not the point. Primary Care Internal Medicine is dead - at the hands of Medicare and the Insurance monopoly - the body is still twitching but it's dead. By the time our leadership both political & medical, do anything substantive about it, it will be too late-- it already is. Then, as the house of cards built upon that moribund foundation collapses, I will watch with a morbid sense of glee and hope that something better can be built from the ruins. No one will follow my generation into it, and I closed my Primary Care practice - PERFORCE - here in rural northern California as I made less than $30K in my last 11 months as a PMD, and have BEEN FORCED to switch to full-time Hospitalist work by the economics of survival - at least I get paid - no where near as much as a Lawyer or surgical specialist mind you, but at least I get paid. So, I simply cannot afford to pay the AMA for doing nothing for me & all of Primary Care. In our tiny community, I had the "blessings" of ALL of the local MD's to take care of their patients, and I am a well-known and respected member of the medical community. That may not be true elsewhere; rather the tattered & failings remnants of Primary Care Docs are turning over their patients to unknown quantities because they are BARELY hanging on trying to see 25-30 patients a day and cannot afford the time away from their office to do (poorly reimbursed) Hospital rounds. They cannot serve their patients or themselves as they simply cannot adequately see an 85-year-old with 20 medical problems, on 15 medications in 10 minutes. And we are fooling ourselves to think we can. So much for a "higher calling". The AMA and many of my colleagues outside of Primary Care are in denial and seem to think the AMA is helping us in Primary Care - it's not; the public seems to think all doctors are rich - we in Primary Care are not & they are not getting it - or not seeing it, but they will in the next 1-2 years. The AMA, our politicians & the public has chosen to turn a blind eye to the "canaries in the mine". It's very easy to put your head in the sand when you don't understand the economics -- we have and ARE still getting 10% pay cuts (and more!) - it's just over 18 months instead of right away -- It's called the COST of LIVING and rising OVERHEAD. The specialties (including primary care) with the lower profit margins are the first to collapse, but it's coming to every Doctors office eventually. Good luck to all of us who will need Primary Care in the next decade or so until something can be built from the rubble as the house of card built on the crumbling foundation of Primary Care collapses. Perhaps everyone will be satisfied by a PA overseen by a "Doctor" Nurse PhD who lacks the training and the acumen to delve into what's really causing their problems and provide optimal care - but you get what you pay for. The point that they're still missing, is that no one will do MY job at ALL given the hassles and ridiculously low pay - even without the threatened 10% cut - even with the "40% better pay" quoted in one of the roundtable articles. Rather, bright students will do something else. And after over 20 years, I simply could not afford to continue. I do not believe that any of the great visionaries in the history of medicine had working for serf-wages while Insurance company execs make millions off our collective toil, and Medicare unloads their burden on us - at our expense - in mind when they laid out the "calling" of medicine. It's hard to believe in a higher calling, when you can't even pay the bills and I do not believe that it is somehow against a higher principle to be able to pay your mortgage, kid's educations and put money away sensibly for retirement rather than proving a burden to your family & on the society you served in your waning years. I am not a Plastic Surgeon, I don't drive a new shiny Mercedes (it's a Subaru and it's 6 years old, my other car is a 21 year old Dodge hatchback) and I did not make even six figures much less seven. No, in my last year of primary care internal medicine I made less than $30,000. Medicine used to be a family affair - kids of Doctors frequently grew up to be Doctors. That's no longer true - rather, like 70% of my colleagues, I would steer the prospective student in another (any other) direction. If they must have Medicine as a career, perhaps we should be HONEST with them & steer them into one of the A.D.O.R.E. (Anesthesia, Dermatology, Ophthalmology, Radiology, ENT/ER) specialties, which at least for the nonce are still reimbursed at some reasonable level and have a reasonable lifestyle. Most of my patients would be insulted to discover that Medicare paid me only $50 to see them in the emergency department, diagnose their myocardial infarction, render life-saving thrombolysis and arrange for transport to the Cath Lab. most patients would be horrified to know that Medicare uses armed auditors (9 mm sidearms I checked). Most Medi-Cal patients have no idea their Doctor was paid $18.10 for that office visit (no matter how long it took) and that's AFTER filling out & filing reams of paperwork. Most patients when confronted with these and so many other wrongs perpetrated against their doctor and the medical community in general, ask what they can do to stop this injustice? The system is broken and platitudes like those I've heard from the AMA and many of my colleagues will not serve to fix the system, rather perpetuate the abuse. One must take arms against a sea of troubles and by opposing, end them. Without REALLY fixing the system, and PAYING Primary Care docs better AND freeing them from the shackles of PPO's HMO's, CMS (Centers for Medicare/Medicaid Services - AKA: Congressionally Mandated Stupidity) & so much more 3rd party nonsense, the patients will be left truly bereft BY THE SYSTEM THAT FORCED ME TO QUIT. A point the AMA seems to have missed - or maybe the AMA just doesn't care about the welfare AND SURVIVAL of their colleagues in Primary Care - certainly that's been my experience in the last 21 years. As a Hospitalist, in the hospital, if I order an MRI, the patient gets an MRI. If I order and expensive medication, the patient gets the expensive medication. If I did that in my office I would need to fill out prior authorizations, go through red tape and arguments from people who don't even have a college education much less medical school. So, the AMA should go ahead doing things they've been doing and pat themselves on the back for a "job well-done"; continue to bury their head in the sand; fiddle while Rome burns around us and rail at the winds that stoke the fire rather than the Government that should be putting the fire out. You do that sirs, but don't be surprised as the coming firestorm of Primary Care's failure engulfs all of us and our patients as well. Since our government & medical leadership lack all vision & only respond to crises (witness the Mortgage mess), that when (not IF) the house of cards falls we can build something better out of the rubble. It's hard to think of much worse for the money we spend on healthcare. Oh, and please don't think I favor a government run, entitlement driven system here in the US - we have 3 systems like that already: 1) the VA - and we've seen how well it takes care of our honored wounded Vets that need their services; 2) CMS also known as Congressionally Mandated Stupidity with 146,000 pages of regulations and ARMED (I checked - 9mm sidearms) auditors; 3) Medicaid/Medi-Cal - I won't even bother to comment. As to the docs who want to try something else, go for it! Don't let naysayers stop you from following your heart. Primary Care is a losing end-game - get out while you can, like any self-preserving rat deserting a sinking ship to save themselves, or drown in the maelstrom to come. Incidentally, it will be harder and harder to find a Primary MD for hospitalized patients, much less a competent one. But our skin, eyes, noses and MRI/CT scans will look marvelous and we'll get that hip repaired when we fall - never mind the fracture and expensive surgery, scans, hospitalization & recovery could have been prevented by a good Primary MD. The AMA is just not getting it. But in the next year or two, we all will. Medicare seems to have understood on some level the total screw up they've perpetrated, and is making some halfhearted gestures in the form of the "medical home" at rethinking some of the gross underpayment of primary care services. Unfortunately, this initiative is poorly thought out, poorly planned, poorly executed, too little and too late. A fact that seems to have escaped them as yet. I am not predicting that the sky is falling, merely observing that the emperor has no clothes. If you wish to use the sky falling analogy, then the meteorites are striking the ground as we speak rendering it again, an observation rather than a prediction. A shame that the AMA, and some of our colleagues are too limited in vision to see that, but again, they will in the very near future. Unfortunately, by that time, it will be too late -- it already is. I urge our colleagues who share the AMA's "vision" to read some of the threads on Medscape; particularly those devoted to primary care practice. Perhaps then their perspective will become enlightened (or darkened depending on your point of view). The challenge today remains as always that the very people most keenly affected by the cynical manipulation of medicine by government (who bear primary responsibility for our present quandary) are those least able to mount a clever, sustained, organized resistance leading to victory...the working doctor!! The hard working doctor is battling not only the complexities of managing patients and their ills, usually a family, who deserve and demand what free time he has left, but in addition, the ever-increasing mounds of paperwork, ridiculous insurance/PBM's & CMS demands and perhaps some outside interests that provide solace and respite, that are healthy and restorative. I believe it is the place of the AMA, who can afford more time to defend, promote and reconstitute medicine in the form that most benefits doctors and patients, to take up that battle - they simply are NOT DOING IT EFFECTIVELY! Part of the reason may be the difficulty in finding or creating unity, sort of like herding cats on fire; and partly they were co-opted into accepting the current system as they make more than dues off of the CPT coding book. They MUST constitute an M.D. interest group, primarily involved in promoting what is best for Primary Care doctors, believing that by and far, a system that is "best for Primary Care doctors" is identical to that system "best for patients"; preventative care and quality "management" from the beginning - rather than spending ridiculous sums of money in the last years of life trying to reverse things that could & should have been prevented. And PLEASE don't talk to me about the "Medical Home" - while the concept may be sound, the execution is execrable. Incidentally, I have been asked by the N. California chapter leader of the ACP to do just that - and sit on a committee to send such "suggestions" to our bought-and-paid-for political leadership. So, I will "buy" a year's membership - something I have not done since the ASIM folded. I honestly think it will go nowhere until the crisis really hits home in a year or so - such is our "reactionary" leadership; when what we need is "visionary" leadership. Even IF Obama were such a leader, he will have to drag Congress & the Senate kicking & screaming to pass any truly sweeping reform. The Insurance, Pharma & Trial lawyer's lobbyists will see to the death of that. I just listened to a great show on NPR - "This American Life" http://feeds.thisamericanlife.org/talpodcast on Health Costs. It's worth listening to - it doesn't just bash the Insurance industry, but Doctors too (this from a Doctor, mind you). I am spending more time with my cosmetic laser business. It's nice to actually have patients that appreciate your work, are willing to pay for it and are truly thankful for the time spent - how refreshing. In addition, unlike I.M. there's actually some immediate gratification from the work. Incidentally, CMS etc. seems to believe that all of medicine can come from a cookbook. While, as a private pilot, I believe there is a SIGNIFICANT role for checklists; I do not believe that "best practices" or "evidence based medicine" is a substitute for the clinician judgement. Yet, we will, in fact, be JUDGED by the various insurance co.'s on whether our patients received peri-op Beta-blockers etc - whether or not, in our (hopefully sound) judgement they should or should not. That's another stupidity about to be foisted on us & what I am lately decrying, not the evolution of medical thought (which is good - it's the difference between science & religion), but the imposition of the "current" thought on us. It IS the job of the AMA to defend the clinician's judgement against the monolithic Insurance industry's "standards" and tell THEM it is not their job to tell us how to practice medicine. But the AMA has truly failed us in so many ways. I see where the collapse of I.M./Primary Care is finally making the headlines...Wonder when our politicians will notice?
Ann smith, MD: The burnout rate among female physicians is much higher than among male physicians. This is manifested by significantly higher suicide rate among female physicians. The burnout rate among female primary care physicans is especially higher than among male counterpart. Three out of 6 my internist partners (all females) ended up in the mental hospital and had to leave medical practice in their 40's and 50's within past 2 years. They were all board certified, very competent and dedicated physicians who were loved by their patients. These are tragedies not only for these physicians but also TERRIBLE LOSS to thousands of their patients and the society. I, the fourth internist in the group, retired at 49 before I, too lose my sanity. The 5th and 6th internists both left the practice and now there is NO internist left in the group! I see similar phenomenon happening all around me. The system where I practiced medicine ranked among top 10 in the country! When is the society going to address this problem?
Lois Freisleben-Cook: I have to say it is not my medical practice that burns me out. It is the almost constant attempts from the local sociopath MD to drive me out of this formerly small town as he has done with many local competing physicians. I have refused to leave and have experienced the abuse of his authority as a member of many committees and the Medical Board. Without this, I would be happily serving the children of this town as their only pediatrician with no expectation of making a lot of money and only the joy of serving where there is truly a need. I have no regrets for the investment I have made in this practice, the meager income I take, the simple lifestyle my husband and I have chosen, the hours, the responsibility. The only time I feel exhausted is when I have to deal with this very sick individual and his actions.

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