Physician burnout has skyrocketed in recent years, leading some to declare the problem a public health crisis. But as occupational burnout becomes more common, the term also gets used more loosely. What exactly is physician burnout, what are its causes, and how bad is it in 2019?
What is physician burnout?
Physician burnout is a condition in which physicians lose satisfaction and a sense of efficacy in their work. This doesn’t mean they are weak or doing anything wrong. Rather, burnout reflects a mismatch between the physician’s values or expectations and the reality of their work environment.
Three diagnostic symptoms of physician burnout were first identified by Christina Maslach and her team in the 1970s:
- Exhaustion – “I’m not sure how much longer I can keep going like this.” You experience physical and emotional exhaustion.
- Compassion fatigue – “I can’t believe they don’t care about their own health.” You are frustrated by patients and families.
- Lack of efficacy – “What’s the use?” You begin to doubt that you are making a difference.
As a physician, you could experience burnout symptoms that are emotional, physical, and behavioral. Emotional symptoms include a sense of failure, self-doubt, sever criticism, decreased interest in work or personal life, and increased anticipator anxiety.
You may also have physical symptoms like tiredness that does not respond to rest, lowered immunity, sleep or appetite changes, and unusual aches and pains. Behavioral symptoms include withdrawal from community involvement, difficulty concentrating, procrastination, and negative attitudes towards patients and coworkers.
If you experience several of these symptoms, you may be on the path to burnout. This doesn’t mean you are weak or that you are doing anything wrong. You are simply operating in a health care system that sets doctors up for burnout.
To learn more about sign and symptoms of physician burnout, see this article by John-Henry Pfifferling, PhD.
What causes physicians burnout?
Health care has changed a lot in the past decade. Physicians increasingly find that the day-to-day demands of their profession are at odds with their commitment to healing and providing care.
Most physicians enter practice hoping to fulfill a caring, supportive, challenging, and rewarding role. What they often get is pressure to see more patients in less time, limited control over how care is delivered, constant scrutiny and “quality” assessments, and increasing demands from patients. Burnout begins when physicians suffer a clash of expectations and see a serious mismatch between their actual day-to-day job and their deep-seated internal expectations.
How bad is it?
78% of doctors suffer from symptoms of burnout
The prevalence of physician burnout has reached critical levels. One 2018 survey found that 78 percent of doctors suffer from symptoms of burnout. This represents a 4 percent increase from 2016.
High levels of physician burnout lead to fewer physician work hours. As a recent report from Harvard summarizes, burnout contributes to a 1 percent reduction in physician personal work effort. The authors note that this reduction “roughly equates to losing the graduates of seven medical schools annually – before accounting for other outcomes of burnout such as early retirement or leaving the profession altogether.”
As physicians loose satisfaction and a sense of efficacy in their work, it isn’t just their mental health that suffers. A health care system fueled by burnt out physicians has clear implications for the health of the American public.
Beating physician burnout
Beating burnout is about building the opposite of burnout, which is engagement. Engagement helps replace exhaustion with enthusiasm, bitterness with compassion, and anxiety with efficacy.
Individual physicians and health care organizations both have a role to play in beating burnout. In their book “Banishing Burnout,” Maslach and Leitner explain how professionals experience burnout when there is a mismatch between their aspirations and reality in one or more of six areas:
- Workload – How much work do you complete in a given day? How frequent are surprising or unexpected events?
- Control – Does your participation in decisions affect your work? Are there quality leaders in upper management?
- Reward – Do you receive recognition for achievements from your supervisors? Are there opportunities for bonuses or raises?
- Community – How frequent are supportive interactions at work? Do you have close personal friendships at work?
- Fairness – Is management dedicated to giving everyone equal consideration? Are there clear and open procedures for allocating rewards and promotions?
- Values – What is the potential of your work to contribute to the larger community? Do you believe your organization’s mission is meaningful?
A mismatch between preference and reality leads to dissatisfaction. While a few mismatches are common, burnout arises from major mismatches in areas that are important to you. Individuals and health care organizations both have a role top lay in addressing major mismatches to guard against physician burnout.