Stethoscope and doctor sitting with laptop stress headache about work in hospital

A study based on surveys of physicians in a large academic
medical practice in the US has shown that burnout among doctors is on the rise
with increasing administrative requirements, loss of autonomy, exhaustion,
practice setting, and resources and choice of specialty implicated as the most
important contributing actors. Early-career physicians were found to be most at
risk.

Marcela G. del Carmen, MD, MPH, from Massachusetts General
Physicians Organization in Boston, and colleagues surveyed 1774 doctors in 2004
and 1882 in 2017 to measure trends and examine factors associated with burnout.
The research is published in the journal JAMA Network.

The researchers observed an increase in burnout from 2014 to
2017, from 40.6% to 45.6%. There was a correlation for the increased rate with
an increase in exhaustion (from 52.9 to 57.7%) and in cynicism (from 44.8 to
51.1%). Early-career physicians (≤10 years since training) were more
susceptible to burnout compared with midcareer physicians (11 to 20 years since
training; odds ratio, 1.36); physicians in their late career (>30 years
since training) were less vulnerable (odds ratio, 0.59).

“We found physicians were more vulnerable to emotional
exhaustion than any of the other subscales of burnout. Physicians reporting
high levels of exhaustion were more likely to reduce their clinical schedules,
reduce the number of patients in their practice, leave the practice, or retire.
The association between burnout and physician clinical work effort, as well as
turnover, has been described extensively in the literature. In a longitudinal
prospective study evaluating the association between burnout and physician
work effort, the authors reported that for every 1-point decrease in
satisfaction, there was a 30% to 40% increase in the likelihood that a
physician would decrease work effort over the subsequent 2 years,” the
researchers wrote.

Their findings also show that there may be a link between
the higher burnout rate and the implementation of new electronic health records
(EHRs).

“Average time spent on administrative tasks increased from
23.7% in 2014 to 27.9% in 2017, and time spent on administrative tasks was
positively associated with higher likelihood of burnout in both the 2014 and
2017 surveys. Others have documented similar findings. In a national study of
6375 physicians, of whom 5389 (84.5%) used an EHR platform, lower rates of
satisfaction with the amount of time spent on clerical tasks and higher burnout
rates were noted. Machine learning and machine intelligence algorithms may
offer an opportunity for consolidation of information in the EHR and provide
relevant summary of these data, sparing clinicians this clerical role,” the researchers
write.

According to them, they also found an increasing mismatch
between physicians’ interests within medicine and the growing demands placed on
them that subtract meaning and joy from practice.

“Increasing administrative requirements, loss of autonomy,
exhaustion, practice setting and resources, and choice of specialty have been
implicated as factors contributing to physician burnout. Medicine can be a
decidedly technical and intellectually challenging profession, characterised by
a continuous demand in the execution of high-stakes decisions that often
require judgement and lack certainty. Relationships with patients and
meaningful intellectual clinical, research, and educational work mitigate the
challenges of this demanding charge. The associations of numerous factors with
burnout and the individual physician are complex and dynamic and change over
time and based on the work environment,” the researchers note.

“Remediation of burnout in healthcare necessitates centrally
and locally designed initiatives. Efforts will also require attention,
recognition, and accountability from executive and regional institutional
leadership. Solutions to address physician burnout will entail shared
commitment from physicians and organisations, as well as physician-, practice-,
and institution-level initiatives,” they conclude.

 

Reference: Del
Carmen MC. Trends and Factors Associated With Physician Burnout at a
Multispecialty Academic Faculty Practice Organization. JAMA Netw Open. 2019;2(3):e190554.
https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2727998