What is Physician Burnout?
Physician burnout has become a national epidemic with multiple studies proving that about half of all doctors suffer from at least one of the three common symptoms associated with this condition. Physician burnout negatively impacts quality of care, patient safety, physician and patient turnover rates, and patient satisfaction in addition to increasing the number of medical errors that have become common in the United States. According to a Mayo Clinic Proceedings study by Daniel Tawfik, MD, medical errors are responsible for 100,000 to 200,000 deaths each year. However, research connecting physician burnout to these errors is limited.
Up until pretty recently, the most prevalent approach to reducing medical errors was to fix the workplace safety by adding in more checklists for physicians to complete and adding in “solutions” like yoga and breathing exercises for the physicians. Tawfik’s study shows that this is insufficient, comparable to placing a Bandaid over a large gash. Fixing these medical errors starts by addressing physician burnout, understanding what it is, how to identify it in yourself and your colleagues, and finding ways to prevent it.
Defining Physician Burnout
An accurate comparison for physician burnout is that energy is like a bank account that can have a positive or negative balance. Every time a physician engages in the activities of their life and medical practice, he or she withdraws energy and the balance decreases. During times of rest and rebalance, energy is deposited, causing that balance to increase. The problem comes when it dips into a negative balance. The account doesn’t close; instead, energy is still spent (in this case working) despite the fact that the currency (energy) is, in fact, depleted.
Burnout is a long-term stress reaction characterized by a series of symptoms we will later discuss that is a result of a constantly depleted energy account and with a negative balance over time. Yes, a physician can continue to function and work in this state but as only a shadow of the doctor that he or she is when the account has a positive balance.
Signs & Symptoms of Physician Burnout
The industry-wide accepted standard for burnout diagnosis is the Maslach Burnout Inventory that was developed in the 1970s by Christina Maslach and her colleagues at the University of San Francisco. She described burnout as “an erosion of the soul caused by a deterioration of one’s values, dignity, spirit, and will.” The three distinct symptoms most commonly associated with physician burnout:
Symptom #1: Physical and Emotional Exhaustion
The physician is feeling both physically and emotionally drained, depleted, worn out, and unable to recover during non-working hours. This is by far the most common symptom of burnout and is the one most physicians identify with when taking burnout prevalence surveys. A thought process that the physician suffering from physical and emotional exhaustion may identify with is, “I’m not sure how much longer I can go on like this.”
Symptom #2: Depersonalization
When physicians display this symptom, it often comes in the form of cynicism, a need to vent about their patients or their job, and a negative or callous attitude. Doctors in this stage are feeling so emotionally drained that they are not emotionally available for their patients or anyone for that matter.
Symptom #3: Reduced Sense of Personal Accomplishment
In this stage of physician burnout, you may begin to doubt the meaning and quality of your work and see yourself as incompetent. A piece of internal dialogue commonly associated with this symptom is thinking, “What does it matter? My work doesn’t really serve a purpose anyway,” or even, “I’m afraid that if I don’t change something, someone is going to get hurt and it’ll be all my fault.”
Effects on patients, practice, and physicians
Physician burnout affects all parties involved: the physician’s patients, the practice, the physician’s family, and, of course, the physician him/herself. Physician burnout is directly linked to a series of unsavory consequences that you definitely want to keep out of your practice:
- Lower patient satisfaction due to poorer quality of care
- Higher physician and staff turnover
- Higher and more severe medical error rates and malpractice risks
- Physician alcohol and drug abuse and addiction
- Higher physician suicide rates
There is a higher risk of death by suicide for both female and male physicians relative to other professionals but goes widely underreported.
Physician burnout fits with the old adage “death by 1,000 paper cuts.” It can happen slowly over time, each day and each task exacerbating the physician’s condition until it comes crashing down with a trigger like a lawsuit, a tragic circumstance in one’s personal life, a significantly damaging medical error, etc. If left untreated, physician burnout will only erode the mental health of doctors and threaten patient care.
