Measuring and Managing Physician Burnout
Physician burnout is widely recognized as a challenge not only for physicians, their families, and their colleagues, but also for the US population that depends on access to engaged and effective healthcare providers. The World Health Organization recently defined burnout as
“A syndrome conceptualized as resulting from chronic workplace stress that has not been successfully managed. It is characterized by three dimensions:
1) Feelings of energy depletion or exhaustion.
2) Increased mental distance from one’s job, or feelings of negativism or cynicism related to one’s job.
3) Reduced professional efficacy.
Burn-out refers specifically to phenomena in the occupational context and should not be applied to describe experiences in other areas of life.”
Despite near-universal awareness, the problem is poorly quantified.
Quantifying the prevalence and severity of burnout is inherently difficult. First, burnout is an internal experience that can only be described by the person suffering from it. Second, burnout is a continuum rather than a binary state.
The Maslach Burnout Inventory (MBI) is the most commonly used measure of physician burnout. The MBI delineates burnout according to three components: emotional exhaustion, depersonalization, and reduced personal accomplishment. However, the cutoff criteria of what constitutes burnout and where to delineate low, medium, or high severity is subjective and varies widely in academic literature.
Other measurement tools have emerged to improve upon the MBI, whether by framing some of the questions negatively or by addressing the high cost of the MBI materials. Alternative approaches include the Copenhagen Burnout Inventory, Oldenberg Burnout Inventory, Patient Health Questionnaire-9 (PHQ-9), Stanford Professional Fulfillment Index, and the Well-Being Index.
The vast array of diagnostic tools and cutoff points can be dizzying, but they all point to the same high-level conclusions:
#1 Burnout affects healthcare providers at higher rates than the overall population
In a 2014 study, approximately 54% of physicians reported at least 1 symptom of burnout, almost twice the rate of the general U.S. working population. Physicians explain that an heavy load of bureaucratic tasks and excessive work hours (especially take-home work) are the primary contributors to emotional exhaustion, depersonalization, and reduced job satisfaction. After all, they “didn’t go to medical school in order to enter data in the EHR.”
#2 Burnout affects primary care providers at higher rates than specialists
In an Archives of Internal Medicine article, researchers noted “substantial differences in burnout were observed by specialty, with the highest rates among physicians at the front line of care access (family medicine, general internal medicine, and emergency medicine).” Confirming this result year in and year out, the annual Medscape survey across 29 specialties consistently places Family Medicine and Internal Medicine in the top 5 for burnout and bottom 5 for happiest at work.
#3 Burnout is reported at higher rates for women than men
Among US physicians, women report burnout at 25% higher rates than men. Researchers note that women may be more likely to admit to psychological problems and seek help than men. Women also disproportionately assume childcare and family responsibilities, increasing the cost of challenges to work-life balance.
Healthcare executives must seek solutions to the root causes of burnout – excessive clerical tasks borne by the provider and the take-home work that results. Without a change, provider turnover will continue to climb and patient access will continue to erode.