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Is your doctor suffering? Do the symptoms include cynicism, emotional exhaustion, or viewing patients as objects rather than people? He or she may be experiencing burnout. In fact, there’s a 50 percent chance that any doctor is—a rate 10 percent higher than among the general population of working people.
The first nationwide study of burnout among doctors in the U.S. offered that grim diagnosis this week. The authors, led by Tait D. Shanafelt of the Mayo Clinic, reported their findings in the Archives of Internal Medicine. About 46 percent of the 7,200 doctors surveyed showed at least one symptom of this condition, described as an “erosion of the soul” in the book, The Truth About Burnout.
For decades, mounting research has confirmed that doctors are not well. Many are stressed out, drug-addicted, depressed and—as Bloomberg Businessweek recently noted—angry. Burnout can bring on those conditions, Shanafelt says. “Some physicians may cope with their distress by using alcohol,” he says, or by giving into rage. “They have a limited reserve because their nerves are frayed a bit.”
Doctors’ enthusiasm for medicine has been waning since the 1970s; half do not recommend the profession to their children. Male doctors are 1.4 times as likely to commit suicide than non-doctors. In recent years, their malaise has led to the creation of physician wellness programs at Vanderbilt University and the University of California, San Diego, to name two. Short-fused physicians have even spawned a booming niche in the anger-management industry.
Burnout worries Shanafelt, an oncologist and professor of medicine, because “burned-out physicians are more likely to make mistakes”—such as the failures of communication or the intimidation that experts say beget medical errors. William Norcross, executive director of a physician wellness program at U.C.S.D. (who had no involvement in the study) concurs. By way of explanation, he adds, “I look at [burnout] as being kind of like a zombie: You lose your feeling, you lose your empathy. You don’t care as much.”
Shanafelt predicts that unhappy doctors will cut back their hours or retire early. In turn, that could further stress the overstretched medical system. For example, he says, it may exacerbate the country’s existing doctor shortage, predicted to grow to more than 60,000 within three years, according to the Association of American Medical Colleges. With baby boomers seeking medical services and Obamacare insuring many more Americans, now would be a bad time for disillusioned doctors to back out.
The study ranked medical specialties by the percentage of doctors who are burned out—or conversely, satisfied with their jobs. Emergency doctors ranked lowest, with a burnout rate of 70 percent, while practitioners in such fields as dermatology and pediatrics were among the most content. Already, Norcross says, prospective doctors have taken notice of older physicians in badly afflicted specialties like general surgery—which the study places last in career satisfaction—and are choosing not to enter them. “Our medical students are seeing general surgeons and primary care physicians burned out, and they don’t want any part,” he says.
Burnout arises from specific conditions, such as when people feel they have too much work, fail to balance work and personal life, or are unable to find meaning in work. Chief among these causes, some experts believe, is lack of time to provide high-quality care. “The financial status of hospitals today depends on the volume of … patients, which runs completely antithetical to the idea of being thorough and complete,” says Kenneth M. Ludmerer, author of Time to Heal, a history of medical education, and a medical historian at Washington University School of Medicine in St. Louis. Because of what he calls low Medicare and Medicaid reimbursement rates, harried doctors and hospitals squeeze in as many patients as possible. This creates a frustrating conflict for doctors who want to practice first-rate medicine, he says.
Balancing work and life has never been easy for physicians, adds Shanafelt. Doctors work longer hours than other professions, the study found. Yet, the considerable rigors of a doctor’s schedule do not explain everything. When the study adjusted for hours worked, doctors were still more burned out than workers in the general population. “The nature of the work—above the hours—seems to be a key factor,” he says.
The feeling of importance in work is undermined by spending endless hours doing paperwork or getting approval for treatments. This “interfacing with the bureaucracy” of modern medicine, as Shanafelt calls it, is a major factor in burnout among physicians.
George Anderson, an anger-management expert who specializes in ill-tempered doctors, has heard the same story many times: Doctors are frustrated by managed care (“mismanaged care” to its critics), a sentiment backed up by research. Since the onset of Nixon-era health-care rules that require doctors to get permission for medical services, they earn less money, yet have more headaches. A doctor who phones an insurance company to get a go-ahead “is dealing with a person on the end of the line who’s an MBA. They are the ones who tell the doctor: “Yes, you can do that” and “No, you can’t.” Before managed care, doctors alone could make that call.
As Anderson attests, some doctors grouse about money. In fact, while physicians rank among the highest-paid professionals, their overall income is down since 2010, according to Medscape figures released this year. Norcross believes that rampart burnout won’t be easy to fix. “It can’t be solved with anti-depressants or increasing somebody’s salary.” Rather, he thinks courses in “mindfulness meditation” and “self awareness exercises,” such as one described in a 2009 Journal of the American Medical Association article, will be key. Among other things, the course involves a day-long “silent retreat” at which doctors perform “yoga-type exercises” and do not talk. A study of that course with doctors demonstrated that it “improved personal well-being,” alleviated burnout, and lifted mood.
Norcross, a 63-year-old physician, feels that a paradigm shift that took place during his career is driving burnout. “Doctors my age went into medicine because we thought it was the greatest calling. … It almost bordered on religion,” he says. “Now it has become more of a business. More of a job than a profession.”