Increasing Rates of Professional Burnout

A recent study (T Shanafelt et al. Mayo Clin Proc. 2015;90(12):1600-1613) indicates that there may be increasing rates of physicians with “Professional Burnout.”  The study is limited by suboptimal response rates but provides some useful information on this topic.

Full text article: Changes in Burnout and Satisfaction With Work-Life Balance in Physicians and the General US Working Population Between 2011 and 2014

Results: Of the 35,922 physicians who received an invitation to participate, 6880 (19.2%) completed surveys. When assessed using the Maslach Burnout Inventory, 54.4% (n=3680) of the physicians reported at least 1 symptom of burnout in 2014 compared with 45.5% (n=3310) in 2011 (P<.001). Satisfaction with work-life balance also declined in physicians between 2011 and 2014 (48.5% vs 40.9%; P<.001). Substantial differences in rates of burnout and satisfaction with work-life balance were observed by specialty.  In contrast to the trends in physicians, minimal changes in burnout or satisfaction with work-life balance were observed between 2011 and 2014 in probability-based samples of working US adults, resulting in an increasing disparity in burnout and satisfaction with work-life balance in physicians relative to the general US working population.  After pooled multivariate analysis adjusting for age, sex, relationship status, and hours worked per week, physicians remained at an increased risk of burnout (odds ratio, 1.97; 95% CI, 1.80-2.16; P<.001) and were less likely to be satisfied with work-life balance (odds ratio, 0.68; 95% CI, 0.62-0.75; P<.001).

The indices that the authors studied included measures of the following (Table 2):

  • Emotional exhaustion
  • Depersonalization
  • Personal Accomplishment
  • Depression: 38% (2011) –>39% (2014)
  • Suicidal ideation: 6.4% (2011) and 6.4% (2014)
  • Burned out rate: 45.5% (2011) –>54.4% (2014)
  • Career satisfaction (would become a doctor again): 70% (2011) –>67% (2014)

Satisfaction with work life balance (Figure 1):

  • Pediatrics generally better than other fields, but close to 50% in 2014 were not satisfied compared with about 40% in 2011 (P <.05).

Take-home message from authors:

Burnout and satisfaction with WLB among US physicians are getting worse. American medicine appears to be at a tipping point with more than half of US physicians experiencing professional burnout. Given the extensive evidence that burnout among physicians has effects on quality of care, patient satisfaction, turnover, and patient safety, these findings have important implications for society at large. 11-20.  There is an urgent need for systematic application of evidence-based interventions addressing the drivers of burnout among physicians. These interventions must address contributing factors in the practice environment rather than focusing exclusively on helping physicians care for themselves and training them to be more resilient.

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Off-Duty Doctors and Family Obligations

A mentor (thanks to WFB) forwarded me a recent article from the NY Times: A Doctor at His Daughter’s Hospital Bed written by a well-known (previous) transplant surgeon.

In essence, this article relates the problem a physician has when he suspects that the care a loved one is receiving is deficient and how strongly to advocate in this circumstance. In fact, this physician ended up grabbing/infusing several bags of IV fluids from a crash cart when the treating team was content to observe.  This article is well-written; I wanted to comment on my own struggles in this area.

First of all some background: one lesson that I learned the hard way was to act on your convictions even when this makes you unpopular.  When I was an intern, I was one of several team members in the care of a child with neurological problems.  I relayed my concerns that the child needed more aggressive care to both my supervising resident and to the subspecialty fellow.  Neither of these physicians acted on the problem.  Later in the day, I spoke with the attending physician.  Ultimately he agreed with my assessment but chided me for not contacting him sooner.  From that day forward, I’ve tried to make sure that if I didn’t get the answer I wanted regarding a patient’s care, that I would keep pursuing the matter until I did.  At the same time, it is worthwhile to try to be pleasant; acting in a nasty manner usually worsens the situation.

For my parents and loved ones, I’ve told them that when someone is hospitalized it is important to always have someone nearby to keep track of what is going on.  What medicine is being given?  Why was that imaging study ordered?  Why are the IV fluids being changed?  When will I see the … physician? This person does not have to be a doctor/healthcare provider, though sometimes that helps.

A few years ago, after an orthopedic surgery, my Mom was recovering in a ‘teaching’ hospital (not in Atlanta).  The surgeon had told me to call him if I had any concerns.  As my Mom returned to her room, I noticed that she did not have a pulse oximeter.  I told the nurse that this concerned me because I knew that she was receiving powerful pain relievers which could decrease her breathing.  The nurse tried to assure me that they would do “spot” checks; she said the hospital was full and there may not be enough pulse oximeters.  I insisted that spot checks were not good enough and to go ahead and contact the surgeon since he had asked me to call him with any concerns.  While I never spoke with a surgeon, the pulse oximeter showed up within five minutes.

About two weeks later, I received a call from Mom early on a Sunday morning.  She was having some chest pain.  I asked her if it had ever happened before and she related that it was the same type of pain she had had a few days after her operation.  She explained that this occurred in the middle of the night at the hospital.  Since the nurse told her the pain was due to anxiety and/or a panic attack [she had never suffered from either previously], neither she nor my Aunt wanted to call and wake me up.  So, on that Sunday, of course, I told her to take an aspirin and go straight to the hospital.  The physicians confirmed that she had had a heart attack.  They placed a stent the next day and she fortunately recovered.

My Dad has had a number of health problems.  On my birthday this year, he had to be transferred to the ER.  After his evaluation, we were told that he would need to be observed in the neurology ICU but there was not a bed available until the morning.  He was going to be monitored in the ER until then.  My twin brother is an early riser.  So that night, we agreed that I would stay with Dad until 4 am and he would take over at that point.  I planned to return to Atlanta to see patients (most had been scheduled for many weeks prior).

Fortunately, around 10 pm, one of the ER staff kindly brought me a comfortable foldout chair.  I tried to get a little rest.  Around 11 pm, a physician entered the ER bay.  Since he did not introduce himself, I questioned whether he was relieving the previous ER physician. He said no; he was a hospitalist.  I then asked whether a bed had opened up in the neurology ICU and whether he would like me to give him a brief summary of what had been happening.  His answer was simply that he did not know what the status of the neurology ICU was and that he did not need any information.  As he was leaving the ER bay, without even the briefest of exams, he said that all of the information that he needed was in the computers.  My response was to ask him if he knew how many CT scans my Dad had had in the past week.  He left without answering.

The next day no physician spoke with us until around 5 pm.  The physician seeing my Dad at that time informed us (me by phone) that this was a followup since my Dad had been seen by their group the previous night.  I informed him that the previous physician had neither examined my Dad nor relayed any type of medical plan.  I am grateful that this physician took the time to hear his background, to apologize for his colleague and develop a plan that helped my Dad improve.  At the same, I am bitter, but perhaps enlightened, by the fact that the previous physician did not care or even act like he did.

What I have learned from the other side (the patient’s side) of the bed:

  1. The hospital that I work at is exceptional (Children’s Healthcare of Atlanta).  The doctors and nurses that I work with care deeply about doing their best every single day.  In fact, this attitude permeates the hospital and includes child life specialists, feeding therapists, ward secretaries, and even maintenance staff.  This is probably true for a lot of children’s hospitals.
  2. In many hospitals, you really have to look out for those you care about to lower the chances that their team will overlook important steps.  Even in really good hospitals, this is important.
  3. While skepticism comes natural for those of us in health care, many family members rely too heavily on the expertise of their nurse or physician.  Engage your health care providers to make sure that they understand what you are trying to tell them.  If the situation changes, make sure your team is updated.
  4. Medication errors are so common.  If you don’t bring the medications with you, make sure you know the dose, the route, and the frequency/timing.  Take pictures of the pill(s) and the prescription or write out all of the prescriptions.  Do not be afraid to ask the nurse to show you the “MAR” (medication administration record) so that the reordered medications match up with those that are taken at home.
  5. Small gestures, like getting a comfortable chair for a family member, can make a big difference.
  6. If you are a physician determined to stay on the sidelines, you may regret that decision.

For physicians/healthcare providers reading this blog, what stories have prompted you to jump from the ‘sidelines back onto the field?’  What advice would you add for families? For nonhealthcare providers reading this blog, what suggestions would you offer?

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