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Burnout Among Physicians Compared With Individuals With a Professional or Doctoral Degree in a Field Outside of Medicine

      To the Editor:
      Medicine is a demanding profession with a long and arduous training process. Once physicians complete training, they engage in meaningful and professionally fulfilling work. They also typically work long hours and deal with a number of profession-specific challenges (eg, dealing with medical errors, risk of malpractice suits, frequent exposure to human suffering, and a rigorous maintenance of the certification process). In recent years, a host of regulatory changes and the more widespread use of electronic health records have increased clerical burden and changed the nature of the physician’s workday.
      • Sinsky C.
      • Colligan L.
      • Li L.
      • et al.
      Allocation of physician time in ambulatory practice: a time and motion study in 4 specialties.
      Collectively, these and other challenges contribute to professional burnout, a syndrome characterized by emotional exhaustion, cynicism (depersonalization), and a decreased sense of efficacy.
      • West C.P.
      • Dyrbye L.N.
      • Shanafelt T.D.
      Physician burnout: contributors, consequences and solutions.
      Since 2011, we have conducted a series of studies evaluating the point prevalence of burnout among physicians as well as US workers in other fields.
      • Shanafelt T.D.
      • Boone S.
      • Tan L.
      • et al.
      Burnout and satisfaction with work-life balance among US physicians relative to the general US population.
      • Shanafelt T.D.
      • Hasan O.
      • Dyrbye L.N.
      • et al.
      Changes in burnout and satisfaction with work-life balance in physicians and the general US working population between 2011 and 2014.

      Shanafelt TD, West CP, Sinsky C, et al. Changes in burnout and satisfaction with work-life integration in physicians and the general US working population between 2011-2017. Mayo Clin Proc. In press.

      These studies have consistently found physicians to be at higher risk for burnout than workers in other fields, even after adjusting for age, sex, relationship status, and work hours. Notably, although increasing levels of education have a protective effect on the risk of burnout among workers in general, this is not true of physicians.
      • Shanafelt T.D.
      • Boone S.
      • Tan L.
      • et al.
      Burnout and satisfaction with work-life balance among US physicians relative to the general US population.
      Although we have previously reported associations between the level of education and the risk of burnout, we have not previously performed a focused analysis comparing physicians with individuals with a professional (eg, JD) or doctoral level (eg, PhD) degree in another discipline. Although the precise nature of their work may differ, these professionals have an educational journey more analogous to that of physicians and may have a more similar set of expectations with respect to work hours and responsibility.
      To explore this, we used data from our 2017 survey of physicians and US workers in other fields.

      Shanafelt TD, West CP, Sinsky C, et al. Changes in burnout and satisfaction with work-life integration in physicians and the general US working population between 2011-2017. Mayo Clin Proc. In press.

      The methods for this study have been described previously. Among the 5198 employed US workers in the study, 285 (5.5%) had a professional degree or doctoral level degree in a field outside of medicine. A comparison of the demographic characteristics, work hours, satisfaction with work-life integration (WLI), and symptoms of burnout among these individuals and the 3971 employed physicians in the study from the same age range (age, 29-65 years) is shown in Table 1. Physicians worked more hours per week, were less satisfied with WLI, and were more likely to experience symptoms of professional burnout. The higher rates of burnout and decreased satisfaction with WLI in physicians persisted in multivariable analysis adjusted for age, sex, relationship status, and hours worked per week (Table 2).
      Table 1Comparison of Employed Physicians in the Sample Aged 29 to 65 y With Employed US Adults Aged 29 to 65 y With a Doctoral Level Degree in a Field Outside of Medicine
      Data are presented as No. (percentage) unless otherwise indicated.
      CharacteristicPhysicians (n=3971)Adults with a PhD/doctoral degree outside of medicine (n=285)P value
      Sex
       Male2279 (57.5)158 (55.4).47
       Female1674 (42.2)127 (44.6)
       Other11 (0.3)
      Age
       Median50.051.0.51
      Relationship status
       Single498 (12.7)55 (19.3)<.001
       Married3233 (82.2)203 (71.2)
       Partnered168 (4.3)20 (7.0)
       Widowed/widower35 (0.9)7 (2.5)
       Missing370
      Hours worked per week<.001
       Mean ± SD52.6±16.144.5±11.7
       Median50.040.0
       <40 h569 (14.6)43 (15.1)<.001
       40-49 h801 (20.5)140 (49.3)
       50-59 h1017 (26.0)65 (22.9)
       60-69 h887 (22.7)26 (9.2)
       70-79 h323 (8.3)7 (2.5)
       ≥80 h309 (7.9)3 (1.1)
       Missing651
      Distress
       Burnout
      As assessed using the single-item measures for emotional exhaustion and depersonalization adapted from the full Maslach Burnout Inventory (MBI). The areas under the receiver operating characteristic curves for the emotional exhaustion and depersonalization 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 emotional exhaustion and depersonalization were 88.2% and 89.6%, respectively.
      Emotional exhaustion
      As assessed using the single-item measures for emotional exhaustion and depersonalization adapted from the full Maslach Burnout Inventory (MBI). The areas under the receiver operating characteristic curves for the emotional exhaustion and depersonalization 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 emotional exhaustion and depersonalization were 88.2% and 89.6%, respectively.
      <.001
      Never473 (12.0)29 (10.2)
      A few times a year863 (21.9)68 (23.9)
      Once a month or less553 (14.0)59 (20.7)
      A few times a month618 (15.7)57 (20.0)
      Once a week390 (9.9)21 (7.4)
      A few times a week585 (14.8)33 (11.6)
      Every day462 (11.7)18 (6.3)
      Missing270
      % High score
      Individuals indicating symptoms of emotional exhaustion symptoms weekly or more often have median emotional exhaustion scores on the full MBI of >30 and have a >75% probability of having a high emotional exhaustion score as defined by the MBI (≥27).
      1437 (36.4)72 (25.3)<.001
      Depersonalization
      As assessed using the single-item measures for emotional exhaustion and depersonalization adapted from the full Maslach Burnout Inventory (MBI). The areas under the receiver operating characteristic curves for the emotional exhaustion and depersonalization 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 emotional exhaustion and depersonalization were 88.2% and 89.6%, respectively.
      .46
      Never1435 (36.4)119 (41.8)
      A few times a year917 (23.3)67 (23.5)
      Once a month or less462 (11.7)32 (11.2)
      A few times a month417 (10.6)29 (10.2)
      Once a week209 (5.3)12 (4.2)
      A few times a week299 (7.6)14 (4.9)
      Every day199 (5.1)12 (4.2)
      Missing330
      % High score
      Individuals indicating symptoms of depersonalization weekly or more often have median depersonalization scores on the full MBI of >13 and have a >85% probability of having a high depersonalization score as defined by the MBI (≥10).
      707 (18.0)38 (13.3).05
      Burnout
      High score (weekly or more often) on the emotional exhaustion and/or depersonalization scale.
      1566 (39.8)82 (28.8)<.001
       Satisfaction with work-life integration
      Work schedule leaves me enough time for my personal/family life:
      Strongly agree422 (10.7)58 (20.4)<.001
      Agree1157 (29.3)103 (36.3)
      Neutral641 (16.2)55 (19.4)
      Disagree1103 (27.9)57 (20.1)
      Strongly disagree626 (15.9)11 (3.9)
      Missing221
      a Data are presented as No. (percentage) unless otherwise indicated.
      b As assessed using the single-item measures for emotional exhaustion and depersonalization adapted from the full Maslach Burnout Inventory (MBI). The areas under the receiver operating characteristic curves for the emotional exhaustion and depersonalization 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 emotional exhaustion and depersonalization were 88.2% and 89.6%, respectively.
      c Individuals indicating symptoms of emotional exhaustion symptoms weekly or more often have median emotional exhaustion scores on the full MBI of >30 and have a >75% probability of having a high emotional exhaustion score as defined by the MBI (≥27).
      d Individuals indicating symptoms of depersonalization weekly or more often have median depersonalization scores on the full MBI of >13 and have a >85% probability of having a high depersonalization score as defined by the MBI (≥10).
      e High score (weekly or more often) on the emotional exhaustion and/or depersonalization scale.
      Table 2Multivariable Model for Burnout
      Model included the following variables: age, sex (male referent), hours worked per week, relationship status, and degree (PhD or professional degree outside of medicine referent).
      Dependent variablePredictorOdds ratio (95% CI)P value
      Burnout
      High score (weekly or more often) on the emotional exhaustion or depersonalizion scale.
      Age (for each year older)0.992 (0.986-0.999).02
      Female (vs male)1.310 (1.145-1.498)<.001
      Married (vs single)0.736 (0.610-0.887).001
      Widowed/widower (vs single)0.366 (0.170-0.790).01
      Hours worked per week (for each additional hour)1.016 (1.012-1.020)<.001
      Physician degree (vs doctoral/professional degree in a field outside of medicine)1.470 (1.122-1.925).005
      a Model included the following variables: age, sex (male referent), hours worked per week, relationship status, and degree (PhD or professional degree outside of medicine referent).
      b High score (weekly or more often) on the emotional exhaustion or depersonalizion scale.
      Several limitations of this analysis should be noted. The total number of professionals in a field outside of medicine included in the sample is relatively small. Although we had limited information about the industry in which these individuals worked, we do not know the exact nature of their degree (eg, JD and PhD) or the precise characteristics of their work. Nonetheless, these results provide important context for the challenge currently experienced by US physicians that may inform future studies comparing physicians with individuals with doctoral level degrees in other fields.

      References

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        • Colligan L.
        • Li L.
        • et al.
        Allocation of physician time in ambulatory practice: a time and motion study in 4 specialties.
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        • West C.P.
        • Dyrbye L.N.
        • Shanafelt T.D.
        Physician burnout: contributors, consequences and solutions.
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        • Shanafelt T.D.
        • Boone S.
        • Tan L.
        • et al.
        Burnout and satisfaction with work-life balance among US physicians relative to the general US population.
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        • Shanafelt T.D.
        • Hasan O.
        • Dyrbye L.N.
        • et al.
        Changes in burnout and satisfaction with work-life balance in physicians and the general US working population between 2011 and 2014.
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      1. Shanafelt TD, West CP, Sinsky C, et al. Changes in burnout and satisfaction with work-life integration in physicians and the general US working population between 2011-2017. Mayo Clin Proc. In press.