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Correspondence: Address to Tait D. Shanafelt, MD, Department of Internal Medicine, Stanford University Medical Center, 300 Pasteur Dr, Stanford, CA 94305.
To evaluate the prevalence of burnout and satisfaction with work-life integration among physicians and other US workers in 2017 compared with 2011 and 2014.
Participants and Methods
Between October 12, 2017, and March 15, 2018, we surveyed US physicians and a probability-based sample of the US working population using methods similar to our 2011 and 2014 studies. A secondary survey with intensive follow-up was conducted in a sample of nonresponders to evaluate response bias. Burnout and work-life integration were measured using standard tools.
Results
Of 30,456 physicians who received an invitation to participate, 5197 (17.1%) completed surveys. Among the 476 physicians in the secondary survey of nonresponders, 248 (52.1%) responded. A comparison of responders in the 2 surveys revealed no significant differences in burnout scores (P=.66), suggesting that participants were representative of US physicians. When assessed using the Maslach Burnout Inventory, 43.9% (2147 of 4893) of the physicians who completed the MBI reported at least one symptom of burnout in 2017 compared with 54.4% (3680 of 6767) in 2014 (P<.001) and 45.5% (3310 of 7227) in 2011 (P=.04). Satisfaction with work-life integration was more favorable in 2017 (42.7% [2056 of 4809]) than in 2014 (40.9% [2718 of 6651]; P<.001) but less favorable than in 2011 (48.5% [3512 of 7244]; P<.001). On multivariate analysis adjusting for age, sex, relationship status, and hours worked per week, physicians were at increased risk for burnout (odds ratio, 1.39; 95% CI, 1.26-1.54; P<.001) and were less likely to be satisfied with work-life integration (odds ratio, 0.77; 95% CI, 0.70-0.85; P<.001) than other working US adults.
Conclusion
Burnout and satisfaction with work-life integration among US physicians improved between 2014 and 2017, with burnout currently near 2011 levels. Physicians remain at increased risk for burnout relative to workers in other fields.
The past decade has been a time of tremendous change in the US health care system. Consolidations and mergers have substantively altered practice structure, with a majority of physicians now in employed practice models.
Health care regulations and policies, including the Affordable Care Act, Meaningful Use, and the Medicare Access and CHIP Reauthorization Act of 2015 have transformed the day-to-day work of US physicians. Widespread penetration of electronic health records (EHRs) has increased administrative burden and led to decreased physician face time with patients.
To the dismay of many physicians, measures of administrative efficiency (eg, how quickly in-box messages are answered or charts closed for billing purposes), imperfect patient satisfaction measures, and productivity metrics (eg, relative value unit generation) have reshaped how many organizations define what it means to be a “good doctor.”
In 2011, we began surveying US physicians and workers in other fields every 3 years to chronicle the changing rates of burnout and satisfaction with work-life integration (WLI) among physicians relative to the general working population. In 2011, 45% of US physicians had at least one manifestation of professional burnout (emotional exhaustion or depersonalization), and problems with burnout and WLI were more common in physicians than in workers in other fields even after adjusting for level of education, hours worked, and other factors.
The American Medical Association (AMA) began working to mitigate physician burnout and promote professional satisfaction in 2012, commissioned a RAND report in 2013, convened numerous meetings of experts, chief executive officers, chief medical officers, and other diverse stakeholders (regulators, payers, EHR vendors), and created online resources and modules.
In early 2017, the National Academy of Medicine launched a large-scale, national, multidisciplinary effort engaging payers, regulators, professional societies, health care organizations, EHR vendors, and others to galvanize efforts to address system issues contributing to the problem.
Recognizing that system-level factors are the primary driver of burnout, a number of large health care organizations have begun to make changes to improve the work environment. Although encouraging results have stemmed from these interventions,
A cluster randomized trial of interventions to improve work conditions and clinician burnout in primary care: results from the Healthy Work Place (HWP) study.
Impact of a national QI programme on reducing electronic health record notifications to clinicians [published online ahead of print March 5, 2018]. BMJ Qual Saf.
organizational efforts remain sporadic and inconsistent. Because many of these efforts are still at a nascent stage, their national impact is unknown. Here, we report the results of the 2017 national survey evaluating changes in burnout and satisfaction with WLI among physicians and other US workers compared with 2011 and 2014.
Participants and Methods
The 2017 survey employed methods similar to the 2011 and 2014 studies.
At all 3 time points, we assessed a range of personal and professional characteristics, as well as several dimensions of well-being.
Study Participants
Physician Sample
A sample of physicians from all specialty disciplines was assembled using the AMA Physician Masterfile. The Masterfile is a nearly complete record of all US physicians independent of AMA membership. Similar to 2011 and 2014, we oversampled physicians in fields other than family medicine, general pediatrics, general internal medicine, and obstetrics/gynecology to ensure an adequate sample of physicians from each specialty. Canvassing e-mails stating the purpose of the study (ie, to better understand the factors that contribute to satisfaction among US physicians), along with an invitation to participate and a link to the survey, were sent to 83,291 physicians on October 12, 2017, with 4 reminder requests sent over the ensuing 6 weeks. A total of 27,071 physicians opened at least 1 invitation e-mail. After completion of the electronic survey, a random sample of 5000 physicians who did not respond to the electronic survey (1426 of whom had opened an e-mail invitation and 3574 had not) were mailed a paper version of the survey on December 6, 2017. Of the 5000 mailed surveys, 269 were returned as undeliverable (80 sent to physicians who had opened an e-mail invitation and 189 who had not). Completed surveys returned by March 15, 2018, were included in the analysis. The 30,456 physicians who opened at least 1 invitation e-mail and/or received a paper mailing of the survey were considered to have received an invitation to participate in the study, while the others were classified as “unable to contact.”
Participation was voluntary, and all responses were anonymous.
To estimate response bias, we also conducted a secondary survey with intensive follow-up in a random sample of 500 physicians who did not respond to the electronic survey.
These individuals were mailed a paper copy of the survey with a $20 incentive to participate. Individuals in the secondary survey who did not respond to the first mailing were sent a second mailing 3 weeks later (without additional compensation). Twenty-four mailed surveys were returned as undeliverable, yielding a final sample of 476. Those who did not respond to the second mailing within 3 weeks were mailed a brief postcard survey requesting basic demographic characteristics and measures of well-being.
Population Sample
For comparison to physicians, we surveyed a probability-based sample of individuals from the general US population from October 13 through October 21, 2017. Consistent with the approach used in 2014, the 2017 population survey oversampled individuals aged 35 to 65 years to better match the age range of practicing US physicians. The population survey was conducted using the KnowledgePanel, a probability-based panel designed to be representative of the US population (http://www.knowledgenetworks.com/knpanel/index.html and http://www.knowledgenetworks.com/ganp/reviewer-info.html). Based on the intent to compare workers in other fields to physicians, only employed individuals were surveyed. The Stanford University and Mayo Clinic institutional review boards reviewed and approved the study.
Study Measures
Both the physician and population controls provided information on demographic characteristics (age, sex, relationship status), hours worked per week, symptoms of burnout, symptoms of depression, suicidal ideation, and satisfaction with WLI. Physician professional characteristics were ascertained by asking physicians about their practice.
Burnout
Burnout among physicians was measured using the emotional exhaustion and depersonalization scales of the Maslach Burnout Inventory (MBI), a validated questionnaire considered the criterion standard tool for measuring burnout.
we considered physicians with a high score on the depersonalization and/or emotional exhaustion subscale of the MBI as having at least one manifestation of professional burnout.
its length and expense limit feasibility for use in long surveys addressing multiple content areas or in large population samples. Thus, to allow comparison of burnout between physicians and population controls, we measured burnout in both groups using 2 single-item measures adapted from the full MBI. These 2 items correlated strongly with the emotional exhaustion and depersonalization domains of burnout measured by the full MBI in a sample of more than 10,000 individuals,
with an area under the receiver operating characteristic curve of 0.94 and 0.93 for emotional exhaustion and depersonalization, respectively, for these single items relative to the full MBI.
Symptoms of Depression
Symptoms of depression among physicians were assessed using the 2-item Primary Care Evaluation of Mental Disorders,
This tool has a high sensitivity but lower specificity such that approximately 1 of every 4 individuals screening positive would meet criteria for major depression if they were to undergo full psychiatric assessment.
Satisfaction With WLI
Satisfaction with WLI was assessed by the item, “My work schedule leaves me enough time for my personal/family life” (response options: strongly agree, agree, neutral, disagree, strongly disagree).
Individuals who indicated “strongly agree” or “agree” were considered to be satisfied with their WLI, whereas those who indicated “disagree” or “strongly disagree” were considered to be dissatisfied with their WLI.
Statistical Analyses
Standard descriptive summary statistics were used to characterize the physician and comparison samples. Associations between variables were evaluated using the Kruskal-Wallis test (continuous variables) or χ2 test (categorical variables), as appropriate. All tests were 2-sided with type I error rates of .05. We used multivariate logistic regression to analyze differences in burnout and WLI in 2017. For other multivariate analyses, we pooled physicians who responded in 2011, 2014, and 2017 and evaluated the risk of burnout or symptoms of depression by participation year after adjusting for age, sex, and practice setting. Finally, a pooled multivariate logistic regression analysis of physicians and workers in other fields was performed to identify demographic and professional characteristics associated with the dependent outcomes. For all comparisons with population comparators, physician data were restricted to responders who were between the ages of 29 and 65 years and not retired to match the population sample. We compared demographic and professional characteristics of physicians responding in 2017 to those of physicians who responded in 2011 and 2014 using χ2 or Kruskal-Wallis tests as appropriate. These data were not paired and were treated as independent samples. Comparisons in the proportions of burnout and satisfaction with WLI between physicians and the general population across 2011, 2014, and 2017 were performed using Breslow-Day tests. All analyses were completed using SAS statistical software, version 9 (SAS Institute).
Results
Well-being of US Physicians
Of the 30,456 physicians who received an invitation to participate either electronically and/or by mail, 5197 (17.1%) completed a survey. To evaluate whether participants were representative of all physicians in the sample, we also conducted a secondary survey with intensive follow-up in a random sample of 476 individuals who did not respond to the electronic survey. With compensation and extensive follow-up, 248 (52.1%) responded. Although the proportion of women participating in the electronic survey was higher than in the secondary survey (39.0% [1583 of 4063] vs 30.4% [75 of 247]; P=.02), we found no statistically significant differences in age (P=.83), years in practice (P=.41), burnout prevalence (full MBI 44.4% [1865 of 4198] vs 42.9% [97 of 226], P=.66), or satisfaction with WLI (41.8% [1694 of 4052] vs 47.4% [117 of 247], P=.09) (Supplemental Table 1, available online at http://www.mayoclinicproceedings.org). These findings support the absence of response bias in the electronic survey respondents with respect to burnout and satisfaction with WLI, suggesting that participants were generally representative of US physicians in these domains. Given the consistency with respect to the experience of burnout and WLI, all responders were subsequently pooled for further analysis.
The demographic characteristics of participants relative to all 890,083 practicing US physicians were generally similar, although participants were slightly older (Table 1). A greater proportion of participants were in specialties other than primary care, consistent with the sampling approach (see “Physician Sample”). The 2017 participants were similar to the 2011 and 2014 participants except for being slightly younger and more largely represented by women, consistent with the increased proportion of women among US physicians in the Masterfile overall (2011, 30.7%; 2014, 33.2%; 2018, 35.0%).
Table 1Demographic Characteristics of Responding Physicians Compared With All US Physicians
Physicians in subspecialty areas were intentionally oversampled to provide an adequate number of responses from physicians from each specialty to allow comparison across specialties. Primary care specialties include internal medicine-general, general practice, family medicine, obstetrics/gynecology, and pediatrics-general.
For further subspecialty breakdown see Supplementary Material.
225 (4.2)
—
321 (4.7)
239 (3.3)
Physical medicine and rehabilitation
131 (2.4)
—
170 (2.5)
97 (1.3)
Preventive medicine/ occupational medicine
30 (0.6)
—
112 (1.6)
76 (1.1)
Psychiatry
432 (8.1)
—
566 (8.3)
488 (6.8)
Radiation oncology
42 (0.8)
—
64 (0.9)
55 (0.8)
Radiology
225 (4.2)
—
261 (3.8)
216 (3.0)
Urology
35 (0.7)
—
119 (1.7)
136 (1.9)
Missing
85
—
66
60
Hours worked per week
Median (IQR)
50 (40-60)
—
50 (40-60)
50 (40-60)
<40
961 (18.9)
—
1172 (17.4)
985 (14.3)
40-49
1053 (20.7)
—
1340 (19.9)
1459 (21.1)
50-59
1245 (24.4)
—
1667 (24.7)
1852 (26.8)
60-69
1084 (21.3)
—
1526 (22.6)
1659 (24.0)
70-79
386 (7.6)
—
535 (7.9)
455 (6.6)
≥80
367 (7.2)
—
509 (7.5)
497 (7.2)
Missing
349
—
131
381
No. of nights on call per week, median (IQR)
1 (0-2)
—
1 (0-3)
1 (0-3)
Primary practice setting
Private practice
2474 (48.0)
—
3605 (52.6)
4087 (57.7)
Academic medical center
1394 (27.1)
—
1625 (23.7)
1494 (21.1)
Veterans hospital
107 (2.1)
—
104 (1.5)
184 (2.6)
Active military practice
55 (1.1)
—
58 (0.8)
65 (0.9)
Not in practice or retired
169 (3.3)
—
160 (2.3)
89 (1.3)
Other
950 (18.5)
—
1303 (19.0)
1164 (16.4)
Missing
296
—
25
205
a IQR = interquartile range; — = not available.
b Data are presented as No. (percentage) unless indicated otherwise. Percentages may not total 100 because of rounding.
c As of October 18, 2017.
d Physicians in subspecialty areas were intentionally oversampled to provide an adequate number of responses from physicians from each specialty to allow comparison across specialties. Primary care specialties include internal medicine-general, general practice, family medicine, obstetrics/gynecology, and pediatrics-general.
Mean emotional exhaustion and depersonalization scores were lower in 2017 than in 2014 (Table 2). The mean emotional exhaustion scores in 2017 remained higher than in 2011 (P=.03), whereas the mean depersonalization scores were slightly lower (P<.001). In aggregate, 43.9% (2147 of 4893) of physicians had at least one manifestation of burnout in 2017 compared with 54.4% (3680 of 6767) in 2014 (P<.001) and 45.5% (3310 of 7227) in 2011 (P=.04). On multivariate analysis pooling responders from the 2011, 2014, and 2017 surveys and adjusted for age, sex, specialty, hours worked per week, and practice setting, physicians who responded in 2017 (odds ratio [OR], 0.606; 95% CI, 0.559-0.657) or 2011 (OR, 0.682; 95% CI, 0.634-0.733) were at lower odds of burnout compared with physicians who responded in 2014 (Supplemental Table 2, available online at http://www.mayoclinicproceedings.org).
Table 2Physician Burnout, Depression, Career Satisfaction, and Satisfaction With Work-Life Integration in 2017 Compared With 2014 and 2011
As assessed using the full Maslach Burnout Inventory. Per the traditional scoring for health care workers, physicians with scores ≥27 on the emotional exhaustion subscale, ≥10 on the depersonalization subscale, or <33 on the personal accomplishment subscale are considered to have a high degree of burnout in that dimension.
High score on emotional exhaustion and/or depersonalization subscales of the Maslach Burnout Inventory (see “Participants and Methods”).
2147/4893 (43.9)
3680/6767 (54.4)
3310/7227 (45.8)
<.001
.04
Depression
Screening positive for depression
2022/4854 (41.7)
2715/6818 (39.8)
2753/7213 (38.2)
.05
<.001
Career satisfaction
Would choose to become a physician again
3508/5122 (68.5)
4476/6676 (67.0)
5081/7236 (70.2)
.10
.04
Work-life integration
Work schedule leaves me enough time for my personal and/or family life
Strongly agree
602 (12.5)
706 (10.6)
1233 (17.0)
<.001
<.001
Agree
1454 (30.2)
2012 (30.3)
2279 (31.5)
Neutral
796 (16.6)
973 (14.6)
1046 (14.4)
Disagree
1272 (26.5)
2004 (30.1)
1775 (24.5)
Strongly disagree
685 (14.2)
956 (14.4)
911 (12.6)
Missing
636
229
44
NA
NA
a NA = not applicable.
b Data are presented as No. (percentage) unless indicated otherwise.
c As assessed using the full Maslach Burnout Inventory. Per the traditional scoring for health care workers, physicians with scores ≥27 on the emotional exhaustion subscale, ≥10 on the depersonalization subscale, or <33 on the personal accomplishment subscale are considered to have a high degree of burnout in that dimension.
d High score on emotional exhaustion and/or depersonalization subscales of the Maslach Burnout Inventory (see “Participants and Methods”).
A more nuanced picture emerged when comparing differences in burnout by specialty at each time point (2011, 2014, 2017), with some specialties experiencing minimal change in the proportion with burnout during the interval (eg, obstetrics and gynecology) and most hitting a peak in burnout in 2014 (Figure 1A). For some specialties, the proportion burned out in 2017 was lower than in 2011 (eg, anesthesiology, emergency medicine, orthopedic surgery) whereas for others the proportion with burnout remained higher in 2017 than in 2011 (eg, dermatology) even though it was lower than in 2014 (Supplemental Table 3, available online at http://www.mayoclinicproceedings.org). Mean emotional exhaustion and depersonalization scores for each specialty by year are shown in Supplemental Table 4 (available online at http://www.mayoclinicproceedings.org).
Figure 1Burnout (A) and satisfaction with work-life integration (WLI) (B) by specialty, 2017, 2014, and 2011.
The proportion of physicians screening positive for depression showed a modest but steady increase between 2011 and 2017 (2011, 38.2% [2753 of 7213]; 2014, 39.8% [2715 of 6818]; 2017, 41.7% [2022 of 4854]; P<.001). On multivariate analysis pooling responders from the 2011, 2014, and 2017 surveys and adjusted for age, sex, specialty, hours worked per week, and practice setting, physicians who responded in 2017 (OR, 1.15; 95% CI, 1.061-1.243) or 2014 (OR, 1.090; 95% CI, 1.014-1.171) were at higher odds of screening positive for depression than physicians who responded in 2011.
Satisfaction with WLI was also greater in 2017 than in 2014 but remained lower than 2011 levels (Table 2). Differences in satisfaction with WLI between 2011 and 2017 by specialty are shown in Figure 1B and Supplemental Table 5 (available online at http://www.mayoclinicproceedings.org).
On multivariate analysis of the 2017 data, being a woman and working more hours per week were independently associated with higher rates of burnout and lower degrees of satisfaction with WLI (Table 3). Practicing in certain specialties was also independently associated with higher or lower rates of burnout.
Table 3Multivariate Models Among Practicing Physicians in 2017
Both models included the following variables: age (<35 years referent category), sex (male referent), relationship status (single referent), specialty (internal medicine subspecialty referent), hours worked per week, and practice setting (private practice referent category).
Both models included the following variables: age (<35 years referent category), sex (male referent), relationship status (single referent), specialty (internal medicine subspecialty referent), hours worked per week, and practice setting (private practice referent category).
Age 35-44 y (vs age <35 y)
0.630 (0.475-0.835)
.001
Age 45-54 y (vs age <35 y)
0.648 (0.488-0.860)
.003
Age 55-64 y (vs age <35 y)
0.643 (0.486-0.851)
.002
Female (vs male)
0.512 (0.444-0.592)
<.001
Hours worked per week (for each additional hour)
0.944 (0.939-0.948)
<.001
a OR = odds ratio; WLI = work-life integration.
b Both models included the following variables: age (<35 years referent category), sex (male referent), relationship status (single referent), specialty (internal medicine subspecialty referent), hours worked per week, and practice setting (private practice referent category).
Comparison of Physicians to the General US Working Population
To compare the professional experience of practicing physicians relative to working US adults, 3971 nonretired physicians aged 29 to 65 years were compared with 5198 employed general population respondents aged 29 to 65 years (Table 4). The overall prevalence of burnout on the 2-item burnout measure for the general US working population in 2017 was similar to 2011 and 2014 (2011, 28.6% [1654 of 5791]; 2014, 28.4% [1532 of 5394]; 2017, 28.1% [1452 of 5169]; comparison 2017 to 2011, P=.58; comparison 2017 to 2014, P=.72). Satisfaction with WLI for the general US working population in 2017 was similar to 2014 and remained more favorable than 2011 (2011, 55.1% [3225 of 5858]; 2014, 61.3% [3320 of 5412]; 2017, 61.0% [3159 of 5179]; comparison 2017 to 2011, P<.001; comparison 2017 to 2014:, P=.71).
Table 4Comparison of Employed Physicians in the Sample Aged 29 to 65 Years With a Probability-Based Sample of the Employed US Population Aged 29 to 65 Years in 2017
As assessed using the single-item measures for emotional exhaustion (EE) and depersonalization (DP) adapted from the full Maslach Burnout Inventory (MBI). Area under the receiver operating characteristic curve for the EE and DP single items relative to that of their respective full MBI domain score in previous studies were 0.94 and 0.93, and the positive predictive values of the single-item thresholds for high levels of EE and DP were 88.2% and 89.6%, respectively.2,34,35
Individuals indicating symptoms of EE weekly or more often have median full MBI EE scores of >30 and have a >75% probability of having a high EE score as defined by the MBI (≥27).
Individuals indicating symptoms of DP weekly or more often have median full MBI DP scores of >13 and have a >85% probability of having a high DP score as defined by the MBI (≥10).
d Protective service, food preparation/service, building cleaning/maintenance, personal care/service.
e Sales representative, retails sales, other sales.
f Construction and extraction, installation/maintenance/repair, precision production (machinist, welder, backer, printer, tailor).
g As assessed using the single-item measures for emotional exhaustion (EE) and depersonalization (DP) adapted from the full Maslach Burnout Inventory (MBI). Area under the receiver operating characteristic curve for the EE and DP single items relative to that of their respective full MBI domain score in previous studies were 0.94 and 0.93, and the positive predictive values of the single-item thresholds for high levels of EE and DP were 88.2% and 89.6%, respectively.
h Individuals indicating symptoms of EE weekly or more often have median full MBI EE scores of >30 and have a >75% probability of having a high EE score as defined by the MBI (≥27).
i Individuals indicating symptoms of DP weekly or more often have median full MBI DP scores of >13 and have a >85% probability of having a high DP score as defined by the MBI (≥10).
Demographic differences between the physician and general population samples in 2017 are shown in Table 4. Similar to 2011 and 2014, physicians reported working a mean of 12 hours more per week (52.6 vs 40.3 hours), with 38.9% of physicians (1519 of 3906) and 6.2% of the general population respondents (320 of 5194) working 60 hours or more per week (P<.001 for both). On the 2-item burnout measure, physicians had higher rates of emotional exhaustion (36.4% [1436 of 3944] vs 24.8% [1285 of 5186]; OR, 1.74; P<.001), depersonalization (18.0% [707 of 3938] vs 13.5% [699 of 5165]; OR, 1.33; P<.001), and overall burnout (39.8% [1566 of 3933] vs 28.1% [1452 of 5169]; OR, 1.69; P<.001) (Figure 2A). After adjusting for age, sex, relationship status, and hours worked per week, physicians remained at increased risk for burnout compared with the general US working population (OR, 1.39; 95% CI, 1.26-1.54; P<.001). Physicians had a lower rate of satisfaction with WLI than the general US working population (40.0% [1579 of 3949] vs 61.0% [3159 of 5179]; OR, 0.43; 95% CI, 0.39-0.46; P<.001) (Figure 2B). After adjusting for age, sex, relationship status, and hours worked per week, physicians remained less likely to be satisfied with WLI compared with the general population (OR, 0.77; 95% CI, 0.70-0.85; P<.001.
Figure 2Changes in burnout (A) and satisfaction with work-life integration (WLI) (B) in physicians and US working population.
The current prevalence of burnout among US physicians appears to be lower than in 2014 and near 2011 levels. This trend is encouraging and suggests improvement is possible despite the numerous contributing factors and complexity of the problem. Although the improvement is good news, symptoms of burnout remain a pervasive problem, and its prevalence among physicians continues to be markedly higher than in the general US working population, even after adjustment for differences in hours worked, age, sex, and relationship status. Notably, the improvement in burnout among physicians has not been realized equally across all specialties, as levels remain higher than in 2011 for many disciplines.
To what can the improvement in the prevalence of physician burnout over the past 3 years be attributed? It is possible that 2014 was a particularly challenging time because of consolidation of hospitals and medical groups, a number of new regulatory factors, increasing EHR penetration, and increased administrative burden.
The situation may be improving as physicians and organizations adapt to the new practice environment. It is also possible that the prevalence of burnout improved due to burned out physicians leaving the workforce or reducing clinical effort.
Medical Practice and Quality Committee of the American College of Physicians Putting patients first by reducing administrative tasks in health care: a position paper of the American College of Physicians.
Even though they are still in their early stages, these efforts may have already made a difference: people are talking about the problems, individuals recognize that they are not alone, and the visible leadership by influential national organizations and accrediting bodies (eg, National Academy of Medicine, AMA, Association of American Medical Colleges, Accreditation Council for Graduate Medical Education, the Joint Commission, American College of Physicians, Accreditation Council for Continuing Medical Education) engaging regulators, payers, and other organizations may provide optimism for meaningful change.
Medical Practice and Quality Committee of the American College of Physicians Putting patients first by reducing administrative tasks in health care: a position paper of the American College of Physicians.
Many organizations have also made substantive efforts to improve the efficiency of the practice environment through better team-based care, documentation assistance, and streamlined workflows.
A cluster randomized trial of interventions to improve work conditions and clinician burnout in primary care: results from the Healthy Work Place (HWP) study.
A cluster randomized trial of interventions to improve work conditions and clinician burnout in primary care: results from the Healthy Work Place (HWP) study.
and should be recognized as potential contributors to the favorable trend.
Despite the modest improvement, our results indicate that burnout among US physicians remains a major problem for the health care delivery system. In our view, the effort to improve health care professional well-being is an ongoing journey, analogous to efforts to improve quality and safety.
A coordinated, systems-based approach at both the national and organizational levels that addresses the underlying drivers is the key to making progress.
Building a program on well-being: key design considerations to meet the unique needs of each organization [published online ahead of print August 21, 2018]. Acad Med.
A formal program to assess, design, coordinate, and lead efforts to reduce the occupational risk for burnout and cultivate professional well-being can help accelerate progress at the organization level.
Building a program on well-being: key design considerations to meet the unique needs of each organization [published online ahead of print August 21, 2018]. Acad Med.
Although the change in burnout is favorable, symptoms of depression among physicians have continued to worsen. Distress is a multidimensional construct that includes burnout, depression, stress, WLI, professional satisfaction, and fatigue as well as other domains. These dimensions of distress have both shared and distinct drivers and do not always move in the same direction.
Our study is subject to several limitations, the potential for response bias being the most important. The majority of physicians did not open the e-mails informing them of the study and accordingly never received the invitation to participate. The participation rate among those who opened the invitation e-mail was only 17.1%. Although consistent with other national survey studies of physicians,
Career satisfaction, practice patterns and burnout among surgical oncologists: report on the quality of life of members of the Society of Surgical Oncology.
The results revealed no statistically significant differences with respect to age (P=.83), years in practice (P=.41), burnout (P=.66), or satisfaction with WLI (P=.09), suggesting that the participants were representative of US physicians. Because our results are based on anonymous responses, we are unable to assess changes in burnout and WLI of individual physicians over time, and the study methodology cannot determine the direction of effect or potential causality between the variables assessed. It is also possible that social desirability bias could alter an individual’s response to items about burnout.
Conclusion
Burnout and satisfaction with WLI among US physicians improved between 2014 and 2017. This trend is reason for optimism and suggests that progress is both possible and under way. Despite this improvement, symptoms of burnout among physicians continue to be prevalent and markedly higher than seen in the general US working population. Given the evidence that burnout impacts patient satisfaction, access, quality of care, and costs, continued efforts to make progress are needed.
Supplemental material can be found online at http://www.mayoclinicproceedings.org. Supplemental material attached to journal articles has not been edited, and the authors take responsibility for the accuracy of all data.
References
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For first time, physician practice owners are not the majority. American Medical Association website.
A cluster randomized trial of interventions to improve work conditions and clinician burnout in primary care: results from the Healthy Work Place (HWP) study.
Impact of a national QI programme on reducing electronic health record notifications to clinicians [published online ahead of print March 5, 2018]. BMJ Qual Saf.
Building a program on well-being: key design considerations to meet the unique needs of each organization [published online ahead of print August 21, 2018]. Acad Med.
Career satisfaction, practice patterns and burnout among surgical oncologists: report on the quality of life of members of the Society of Surgical Oncology.
Grant Support: Funding for this study was provided by the Stanford Medicine WellMD Center , the American Medical Association , and the Mayo Clinic Department of Medicine Program on Physician Well-being.
Potential Competing Interests: The authors report no competing interests.
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