Physician Burnout

One of the most challenging issues facing healthcare today is physician burnout.

What Is Physician Burnout?

Burnout is characterized by exhaustion and cynicism, leading to decreased engagement in daily work.¹ Burnout is distinguished from depression in that it is specifically related to circumstances of the workplace and does not include the overall sense of defeat.²

Physician burnout has been increasing over the last 7 years and appears to be reaching a critical mass in the United States with more than 50% of practicing physicians reporting at least 1 symptom of burnout, a significantly higher percentage than in the general population.^3,4 Physician burnout is increasingly prevalent in primary care, as more than 60% of family medicine physicians and general internal medicine physicians experience burnout. The level of burnout among neurologists is not far behind, with 50% to 60% of neurologists meeting one criterion for burnout.^3,5 In fact, emergency medicine has been the only specialty with higher burnout rates than neurology or internal medicine.³

What Causes Physician Burnout?

Many professional and employment factors correlate with physician burnout, including practice setting (community vs academic); a shift from owning a practice to employment; the burden of clerical and administrative work, which may take twice as much time of the physician’s time as clinical care⁶; dissatisfaction with work-life balance; and long hours and nights on call/week. Factors that alleviate the risk of burnout in the general population, which include higher education and professional degree, may have an inverse effect on the risk of physician burnout.³ Interestingly in neurology, none of these is the strongest correlation, however. Instead, neurologists’ risk of burnout most closely correlates with having difficulty finding meaning in their daily work⁴.

Why Physician Burnout Matters

Understanding burnout among physicians and within medical specialties is essential, as the impact of this growing phenomenon has effects on quality of life and outcomes for both physicians and their patients.^7,8

Physicians with burnout experience higher rates of substance abuse, depression and suicide.⁹ They are more likely to make errors in prescribing and safety, potentially damaging their professional livelihood. Their ability to remain empathetic is compromised, which also creates disengagement, turning burnout into a vicious cycle. Burnout also correlates with early retirement, chasing competent physicians out of practice.

Patients who experience physicians with less empathy have a higher treatment burden, are more likely to experience medical errors, and have worse outcomes. In the United States, one of the main concerns of particular interest to neurologists is that of multimorbidity in an aging population.¹⁰ Patients experiencing multimorbidity tend to use healthcare resources more frequently, having more appointments, physicians, diagnostic tests, and treatments than those without multimorbidity.¹¹ As a result, the patient experiences not only the burden of the illnesses, but also the burden of treatment for those illnesses.¹² Treatment burden also includes the stress experienced by patients when there are multiple demands placed on them as the result of their ongoing care regimen along with other stressors in the patient’s life.¹³ High treatment burden may lead to poor adherence to a plan of care, resulting in unfavorable clinical outcomes.¹⁴ It is essential that physicians are aware of and empathetic to their patient’s burden of treatment to achieve optimal outcomes.

What Can Be Done About Physician Burnout?

Given the complex causes of physician burnout, it is unlikely that there is a simple or one-size-fits-all solution, and the economics of decreasing burnout may not align with the aim of reducing the cost of care in all systems. However, there are ways for individuals to lead the way in addressing the problem. In their article detailing levels of burnout among neurologists, Neil Busis and colleagues⁵ propose that engagement, “(a) positive state of fulfillment that is characterized by vigor, dedication, and absorption,” is the inverse of burnout and recommend strategies for increasing engagement as a potential solution in the specialty of neurology. These include engaging with local and national organizations of neurologists both online and in person, participation in counseling and mentoring programs, creating a culture of professional growth, and recognizing one anothers’ professional accomplishments. In online discussion of that article, discussants also suggested meditation, mindfulness, and exercise as individual ways to address the issue of burnout.

1. Shanafelt TD, Dyrbye LN, and West CP. Addressing physician burnout: the way forward. JAMA. 2017;317(9):901-902.

2. Brenninkmeyer V, Van Yperen NW, and Buunk BP. Burnout and depression are not identical twins: is decline of superiority a distinguishing feature? Personality and Individual Differences. 2001;30(5):873-880.

3. Shanafelt TD, Boone S, Tan L, et al. Burnout and satisfaction with work-life balance among US physicians relative to the general US population. Arch Intern Med.. 2012;172(18):1377-1385.

4. Shanafelt, TD, Hasan O, Dyrbye LN, et al. Changes in burnout and satisfaction with work-life balance in physicians and the general US working population between 2011 and 2014. Mayo Clin Proc. 2015; 90(12)12:1600-1613.

5. Busis NA, Shanafelt TD, Keran CM et al. Burnout, career satisfaction, and well-being among US neurologists in 2016. Neurology .2017; 88(8):797-808.

6. Sinsky C, Colligan L, Li L, Prgomet M, et al. Allocation of physician time in ambulatory practice: a time and motion study in 4 specialties. Ann Intern Med. 2016;165:753-760.

7. Scheepers RA, Boerebach BC, Arah OA, Heineman, MJ, and Lombarts, KM. A systematic review of the impact of physicians’ occupational well-being on the quality of patient care. Int J Behav Med. 2015: 22(6):683-698.

8. Wallace JE, Lemaire JB, and Ghali WA. Physician wellness: a missing quality indicator. Lancet. 2009;374(9702);1714-1721.

9. Sigsbee B, Bernat JL. Physician burnout: a neurologic crisis. Neurology .2014;83:2302-2306.

10. Mercer SW, Smith SM, Wyke S, O’Dowd T, and Watt GC. Multimorbidity in primary care: developing the research agenda. Fam Pract. 2009;26(2):79-80.

11. May CR, Eton DT, Boehmer K, et al. Rethinking the patient: using Burden of Treatment Theory to understand the changing dynamics of illness. BMC Health Serv Res. 2014:14(1):281.

12. Wolff JL, Starfield B, and Anderson G. Prevalence, expenditures, and complications of multiple chronic conditions in the elderly. Arch Intern Med. 2002;162(20):2269-2276.

13. Eton DT, Ridgeway JL, Egginton JS, et al. Finalizing a measurement framework for the burden of treatment in complex patients with chronic conditions. Patient Relat Outcome Meas. 2012;6:117.

14. Ridgeway JL, Egginton JS, Tiedje K. Factors that lessen the burden of treatment in complex patients with chronic conditions: a qualitative study. Patient Prefer Adherence. 2014;8:339-351.