Physician Burnout: A Ticking Time Bomb

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Burnout — a term physicians are all too familiar with. Grueling hours, demanding work, administrative burdens, and inefficient medical systems all contribute to the physical, mental, and emotional exhaustion experienced by clinicians. Recent reports of physician burnout are so alarming that the American Medical Association (AMA) now refers to it as a health crisis of its own.1 

The American Psychological Association (APA) defines burnout as “physical, emotional or mental exhaustion, accompanied by decreased motivation, lowered performance and negative attitudes towards oneself and others.”2 Burnout is common in service-oriented professions with high-performance environments that require long hours and extensive physical and mental exertion. In fact, a 2021 survey conducted by the APA found that 79% of adult workers experienced work-related stress and nearly 60% reported that it negatively affected their lives.3

Although physician burnout has been an ever-present issue looming in the background, recent data show that its prevalence has nearly doubled over the past few years. It seems to be a ticking time bomb, with many providers threatening to cut back hours or leave their practice entirely. A physician shortage in an already short-staffed country could turn disastrous if changes are not made soon.

Physician Burnout Is More Common Than You Think

Many physicians feel that they are on their own or should not be struggling with the long-term stress and emotional impact of working with patients. However, physician burnout has been a concern for decades. In a report from JAMA Internal Medicine published in 2012, 45.8% of physicians reported experiencing at least 1 symptom of burnout.4 

Now, recent data show a staggering increase in burnout, leading many in the health care industry to wonder when the other shoe will drop. A 2022 study conducted by Shanafelt and colleagues and published in Mayo Clinic Proceedings reported on findings from the authors’ survey of 2440 US physicians. Overall, 62.8% of responding physicians reported experiencing at least 1 symptom of burnout, reflecting a stark increase from recent years.5 The study authors also noted a 25% increase in burnout from the end of 2020 to the end of 2021.

Equally as concerning is the rate of depression in physicians. While the prevalence of depression is approximately 8% in the general population, 29% of medical residents report experiencing depression.6 According to the Association of American Medical Colleges, the rate of suicide among physicians is nearly double that of the general population.

Understanding the driving forces behind burnout and knowing the signs can help physicians seek help when they need it, preferably before the situation becomes critical. But this may be easier said than done.

Administrative Burdens, Lack of Work-Life Balance, and Exhaustion Drive Physician Burnout

Physicians have a physically, mentally, and emotionally taxing job. They have to treat sick, frightened, or dying patients on a daily basis, including meeting with their families and/or caregivers and completely seemingly endless bureaucratic tasks, all on a schedule that is out of their control. As time goes on, the relentless nature of this occupation takes its toll on many caring and compassionate physicians.

Physician burnout does not appear to be caused by any single factor; instead, it occurs as the result of an accumulation of stresses associated with the work environment, increased pressure to perform, extensive work hours, and countless other demands. The following are some of the many factors driving this phenomenon.

Administrative Burdens and Incorporation of Electronic Health Records

The AMA recognizes that administrative burdens and bureaucratic tasks like documentation, ordering laboratory studies and medication, and speaking with insurance companies largely drive physician burnout. Christine Sinsky, MD, AMA Vice President of Professional Satisfaction, states, “While burnout manifests in individuals, it originates in systems. Burnout is not the result of a deficiency in resilience among physicians; rather, it is due to the systems in which physicians work.”7

Technological advances often alleviate the burden of cumbersome tasks. Outdated, paper-based health records have been largely replaced by electronic health records (EHRs). These systems give physicians access to the most accurate and up-to-date patient information and allow for coordinated care between providers.8

While the Office of the National Coordinator for Health Information Technology states that EHRs can also help improve productivity and work-life balance for physicians, this dream has yet to be realized. Many physicians report that EHRs actually contribute to their burnout symptoms. Authors of a study published in the New England Journal of Medicine found that for every 1 hour that physicians spend with patients, they spend an additional 1 to 2 hours documenting their visits, prescribing medications, and ordering additional tests.9 Authors of another survey of 585 primary care physicians found that 37% of them experienced burnout; of those physicians, three-quarters of them attributed their symptoms to EHR work.10

High Expectations and the Medical Education System

From the very beginning, physicians are held to extremely high standards throughout their schooling and training. Dike Drummond, MD, penned an article in Family Practice Management focusing on the 5 main causes of physician burnout, with one of them being the influence of medical education.11

Physicians often push themselves to overperform and be “workaholics” and perfectionists while in school and residency. “The same traits responsible for our success as physicians simultaneously set us up for burnout down the road,” writes Dr Drummond.11 There is also a cultural stigma in the medical field surrounding mental health. Physicians are less likely to reach out for mental health services and help out of fear of jeopardizing their medical license.1 They also struggle to find accessible services that offer care during their overloaded workday.

Lack of Work-Life Balance

The term “work-life balance” is often thrown around these days as a goal to strive for. In an ideal world, everyone would be able to strike the perfect balance between work, family, friends, and hobbies; however, this is rarely the case for physicians. 

In fact, Dr Drummond notes that medical residents are often taught the exact opposite during their training.11 Generations of residents have passed down the practice of ignoring emotional and spiritual needs out of fear of weakness. Although the average US work week is 40 hours, most physicians find themselves working 40 to 60 hours each week.12 Even more startling is that nearly 25% of physicians report working between 61 and 80 hours each week.

Shanafelt and colleagues found in their survey that satisfaction with work-life integration (as it is termed in the study) decreased by 15.8% from 2020 to 2021.5 Long hours leave physicians’ schedules too packed to enjoy time with their families, pursue hobbies, and simply take time for themselves. Some physicians may also face challenges in their home life that leave little room for relaxation.

Time Pressure

Depending on the specialty, physicians can see up to dozens of patients every day. The pressure to examine and treat as many patients as possible is a looming presence. Outcomes from the Minimizing Error, Maximizing Outcome (MEMO) study conducted by the Agency for Healthcare Research and Quality revealed that more than 50% of physicians reported experiencing stress from time pressure.13

Specifically, the study revealed that more than one-half of physicians feel pressure to conduct physical examinations quickly. Many also state that they need more time than their appointments allow to provide necessary patient care.13 Constantly working against the clock contributes to physician burnout, especially if they are trying to reach an unattainable goal of seeing so many patients every day.

Who Is More Likely to Experience Physician Burnout?

Physicians in any specialty can experience burnout, but it is more common in some than others. Medscape surveyed more than 9100 physicians across dozens of specialties to learn more about their experiences with burnout and depression.14 Approximately 65% of emergency medicine physicians reported experiencing burnout, and similar rates were reported by physicians in other specialties:

• Internal Medicine: 60%
• Pediatrics: 59%
• Obstetrics/Gynecology: 58%
• Infectious Diseases: 58%
• Family Medicine: 57%

Specialties in which physicians report the lowest rates of burnout include public health and preventive medicine (37%), pathology (39%), cardiology (43%), and nephrology (44%).14

Reports and surveys also show that female physicians are more likely to report experiencing burnout compared with their male counterparts. The Medscape physician survey found that 63% of female physicians experienced burnout compared with 46% of male physicians.14

Feeling Stressed or Emotionally Detached? It May Be Burnout

According to Dr Drummond, physicians who are burning out often enter “survival mode,” during which they simply try to push through their day so they can make it home.11 Over time, physicians become less motivated, less interested in their work, and less invested in their patients.

In the 1970s, Christina Malasch, PhD, and colleagues determined the 3 main signs of burnout to be exhaustion, decreased personal achievement, and depersonalization.11 Other generalized signs of burnout include15:

• Feeling anxious, angry, frustrated, or frightened
• Having the inability to feel contentment, happiness, or pleasure, especially surrounding their career
• Physical symptoms, including headaches, gastrointestinal problems, difficulty sleeping, and muscle tension

Exhaustion

Exhaustion means more than simply feeling tired; physicians can experience physical, mental, and emotional exhaustion.11 During burnout, energy levels, mental health, and critical thinking skills all head toward a downward spiral.

Common signs of exhaustion in physicians include:

• Constantly feeling tired or run-down
• Struggling to get out of bed in the morning or for their shift
• Coming home feeling exhausted and drained, leaving little energy for cooking, cleaning, and spending time with family
• Thinking, “I’m not sure how much longer I can keep doing this.”

Decreased Personal Achievement

Another sign of physician burnout is feeling decreased personal achievement or having negative views on one’s work and worth.11,15 For example, a physician may feel that they cannot do anything right at their job or as if they are not making a difference. Physicians may:

• View themselves in a negative light
• Have low morale or self-esteem
• Feel like their job does not serve a purpose or they are not helping anyone

They may also constantly doubt the quality of their work, waiting to make mistakes that will result in disciplinary action or termination.

Depersonalization

Many physicians spend hours each day connecting with patients to build trust and meet their needs. Burnout often puts patient interactions in a newer, darker light, and many physicians find themselves feeling emotionally detached from their jobs. This attitude and outlook is known as depersonalization.16

Instead of viewing their patients with kindness and compassion, depersonalization causes physicians to act negatively or indifferently toward them. These attitudes can also extend to colleagues and the medical profession in general.16

Side Effects of Physician Burnout

Physician burnout affects not only physicians but also the scope and quality of care that patients receive. Exhausted and burned-out providers are more likely to make medical errors and struggle to connect with patients.17 A survey from 2014 found that 10.5% of physicians had made at least 1 major medical error in recent months. Of them, 77% had experienced symptoms of burnout.18 Burnout is also associated with more malpractice claims and generally erodes the trust and relationship between physicians and patients.19

The combination of patient dissatisfaction, pressure to perform, and a broken support system has the potential to push physicians out of their chosen field. With fewer physicians in practice, patients will have reduced access to care. Even when burned-out physicians stay in their position, they are more likely to cut back their efforts, consistently perform suboptimal work, and take more sick days.19

Available Resources for Physician Burnout 

So, what can be done to defuse the issue of physician burnout? Medical organizations — including the AMA and the American College of Physicians — are actively working toward driving changes in the medical field by offering resources and training programs on burnout. 

The most important thing physicians can do is to take steps to prevent burnout before it starts. Mamta Gautam, MD, published an article in the AMA Journal of Ethics that recommends physicians focus on what they can control, schedule regular breaks and vacations, and recognize that sometimes, “Good enough is good enough. Set realistic expectations of yourself.”20

The following links provide access to several continuing medical education (CME) courses, podcasts, wellness apps, and toolkits for physicians to build their skillsets and manage burnout.7,21,22

References

1. Resneck J Jr. Burnout is a health crisis for doctors—and patients. American Medical Association. Published March 9, 2023. Accessed July 21, 2023. https://www.ama-assn.org/about/leadership/burnout-health-crisis-doctors-and-patients 
2. Burnout. American Psychological Association. Accessed July 21, 2023. https://dictionary.apa.org/burnout 
3. Abramson A. Burnout and stress are everywhere. American Psychological Association. Published January 1, 2022. Accessed July 21, 2023. https://www.apa.org/monitor/2022/01/special-burnout-stress 
4. Shanafelt TD, Boone S, Tan L, et al. Burnout and satisfaction with work-life balance among US physicians relative to the general US population. 2012;172(18):1377-1385. doi:10.1001/archinternmed.2012.3199
5. Shanafelt TD, West CP, Dyrbye LN, et al. Changes in burnout and satisfaction with work-life integration in physicians during the first 2 years of the COVID-19 pandemic. Mayo Clin Proc. 2022;97(12):2248-2258. doi:10.1016/j.mayocp.2022.09.002
6. Weiner S. Out of the shadows: physicians share their mental health struggles. Association of American Medical Colleges. Published March 28, 2023. Accessed July 21, 2023. https://www.aamc.org/news/out-shadows-physicians-share-their-mental-health-struggles 
7. What is physician burnout? American Medical Association. Published February 16, 2023. Accessed July 21, 2023. https://www.ama-assn.org/practice-management/physician-health/what-physician-burnout 
8. Advantages of electronic health records. The Office of the National Coordinator for Health Information Technology. Reviewed March 8, 2022. Accessed July 21, 2023. https://www.healthit.gov/faq/what-are-advantages-electronic-health-records 
9. Wright AA, Katz IT. Beyond burnout — redesigning care to restore meaning and sanity for physicians. N Engl J Med. 2018;378(4):309-311. doi:10.1056/NEJMp1716845
10. Robertson SL, Robinson MD, Reid A. Electronic health record effects on work-life balance and burnout within the I3 population collaborative. J Grad Med Educ. 2017;9(4):479-484. doi:10.4300%2FJGME-D-16-00123.1
11. Drummond D. Physician burnout: its origin, symptoms, and five main causes. Fam Pract Manag. 2015;22(5):42-47.
12. How many hours are in the average physician workweek? American Medical Association. Published January 6, 2015. Accessed July 21, 2023. https://www.ama-assn.org/practice-management/physician-health/how-many-hours-are-average-physician-workweek 
13. Physician burnout. Agency for Healthcare Research and Quality. Updated February 2023. Accessed July 21, 2023. https://www.ahrq.gov/prevention/clinician/ahrq-works/burnout/index.html
14. Kane L. ‘I cry but no one cares’: physician burnout & depression report 2023. Medscape. Published January 27, 2023. Accessed July 21, 2023. https://www.medscape.com/slideshow/2023-lifestyle-burnout-6016058#1 
15. Mealer M, Moss M, Good V, Gozal D, Kleinpell R, Sessler C. What is burnout syndrome (BOS)? Am J Respir Crit Care Med. 2016;194:1-2. doi:10.1164/rccm.1941P1
16. Romani M, Ashkar K. Burnout among physicians. Libyan J Med. 2014;9:19.3402/ljm.v9.23556. doi:10.3402%2Fljm.v9.23556
17. Patel RS, Bachu R, Adikey A, Malik M, Shah M. Factors related to physician burnout and its consequences: a review. Behav Sci (Basel). 2018;8(11):98. doi:10.3390%2Fbs8110098
18. Tawfik DS, Profit J, Morgenthaler TI, et al. Physician burnout, well-being, and work unit safety grades in relationship to reported medical errors. Mayo Clin Proc. 2018;93(11):1571-1580. doi:10.1016%2Fj.mayocp.2018.05.014
19. Extent and consequences of clinician burnout. In: Taking Action Against Clinician Burnout: A Systems Approach to Professional Well-Being. National Academies Press (US); 2019.
20. Gautam M. Before burnout: how physicians can defuse stress. Virtual Mentor. 2003;5(9):394-397. doi:10.1001/virtualmentor.2003.5.9.pfor1-0309
21. Individual physician wellness and burnout tools. American College of Physicians. Accessed July 21, 2023. https://www.acponline.org/practice-resources/physician-well-being-and-professional-fulfillment/individual-physician-wellness-and-burnout-tools 
22. Physician burnout & wellness CME course. AMA Ed Hub. Accessed July 21, 2023. https://edhub.ama-assn.org/course/279