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STRESSED OUT
REPORT REVEALS SEVERITY
OF BURNOUT BY SPECIALTY
By Troy Parks, Staff Writer for the American Medical Association
Physicians from 27 specialties graded the severity of their
burnout on a scale of one to seven in a recent Medscape survey —
one being that it does not interfere, and seven indicating thoughts
of leaving medicine. All but one specialty selected a four or higher.
The most affected specialty? Emergency medicine, with nearly 60
percent of ED physicians saying they feel burned out, up from half
in 2013. How can the rising prevalence and severity of burnout
be addressed? Regulatory, systemic and practice environment issues
appear to be key.
Too many bureaucratic tasks, spending too many hours at work,
feeling like just a cog in a wheel, increased computerization of prac-
tice: In the “Medscape Lifestyle Report 2017,” more than 14,000
physicians surveyed designated these four concerns as the top causes
of burnout.
“Today’s medical practice environment is destroying the altruism
and commitment of our physicians,” said Tait Shanafelt, MD, a
hematologist and physician-burnout researcher at the Mayo Clinic,
in a presentation at a NEJM Catalyst event last June. “We need to
stop blaming individuals and treat physician burnout as a system
issue … If it affects half our physicians, it is indirectly affecting half get in the way of a physician’s ability to provide care to a patient,
our patients.”
Dr. Shanafelt delivered a presentation that same month at the
2016 AMA Annual Meeting in Chicago, where he examined this
scenario: “If I told you we had a system issue that affected quality
of care, limited access to care, and eroded patient satisfaction … you
would immediately assign a team of systems engineers, physicians,
administrators at your center to fix that problem rapidly.”
And burnout is a system issue just like that, Dr. Shanafelt said.
In order to address the issue, the focus should be on changing the
practice environment and the system, but “we have not mobilized
the way we would to address other factors affecting quality, access
and patient satisfaction,” he said.
Related Coverage
A double-edged sword: What makes doctors great also drives
burnout
In 2013, the first year of the “Medscape Lifestyle Report,” emer-
gency medicine had the highest rates of burnout at just over 50 per-
22 San Antonio Medicine • April 2017
cent. That specialty, in 2017, is now close to 60 percent. Meanwhile,
on the severity scale urology landed in the uncoveted top spot with
a 4.6 rating. That compares with a 4.2 burnout severity rating for
emergency medicine. Infectious disease medicine physicians rated
their burnout severity lowest, at 3.9 on the seven-point scale. Yet,
over the four years between reports, infectious disease medicine
burnout rates rose 15 percentage points to make that specialty the
fifth highest in share of physician burnout.
For infectious disease medicine, it is hard to ignore the two pan-
demics that arose. First, Ebola entered the global sphere in 2014
and put pressure on infectious disease specialists, and it was almost
immediately followed by the Zika virus.
Rheumatology also saw a big jump in burnout. While about one-
third of rheumatologists reported burnout in 2013, more than half
scored as burned out in the 2017 edition of the Medscape report.
Pediatrics, cardiology and general surgery also saw increases in
burnout over the years. No specialty reported less burnout.
When the types of issues identified by physicians in this report
burnout symptoms may present. “[Burnout] primarily relates to
your professional spirit of life, and it primarily affects individuals
whose work involves an intense interaction with people,” Dr.
Shanafelt said.
The question then arises whether physician burnout differs from
the general working population. The AMA and the Mayo Clinic
provided an answer in a recent study published in Mayo Clinic Pro-
ceedings. Compared with the general U.S. population, physicians
worked a median of 10 hours more per week, displayed higher rates
of emotional exhaustion and reported lower satisfaction with work-
life balance, the study found.
Though the general U.S. population does experience burnout,
the current state of the health care system is clearly driving increases
in physician burnout at a higher rate.
Organizations can make positive changes
One practice in Minneapolis, not far from the Mayo Clinic,
found a simple solution to provide their physicians and staff a space
to “reset.” Hennepin County Medical Center, through their Office