Burnout in Physicians _ _______________________________________________________________________
RATES OF DEPRESSION AND BURNOUT BY SPECIALTY AREA OR STAGE OF CAREER
Subjects
Rate of Depression
Rate of Burnout
Gynecologic oncologists
33%
32%
General internists
40%
53%
Surgeons
30%
40%
Early-career physicians
40%
51%
Residents/fellows
51%
60%
Medical students
58%
56%
Source: [34; 40; 43; 49]
Table 7
residents at high risk for both burnout and depression reported multiple medical errors within the previous year compared with residents at low risk (33% vs. 0.7%) [41]. Burnout was also associated with self-reports of suboptimal care in a study of emergency medicine physicians and residents. The authors completed a burnout evaluation and asked six questions to assess suboptimal care; physicians who had high burnout scores were more likely to report all six acts of subop- timal care [28]. In another study, reporting a major medical error during the last three months was significantly associated with burnout among surgeons [83]. The depersonalization domain had the most effect; for each 1-point increase in the score in this domain, there was an 11% increase in the likeli- hood of reporting an error, and for each 1-point increase in the score on the emotional exhaustion scale, there was a 5% increase in likelihood. In multivariate analysis that controlled for other personal and professional factors, burnout was an independent predictor of reporting a major medical error. In contrast to these findings, studies of family physicians and general internists have shown no consistent relationships between burnout, medical errors, and quality of care [29; 54]. With regard to patient satisfaction, a preliminary study involved a survey of 178 matched pairs of physicians and patients who had been hospitalized in the previous year. The authors found that a high score on the depersonalization domain was associ- ated with lower rate of patient satisfaction and longer recovery after hospital discharge (after controlling for factors such as severity of illness) [84]. STRATEGIES TO PREVENT AND COPE WITH STRESS AND BURNOUT There are two primary approaches to preventing and/or coping with stress and burnout. Given that the most significant factors in burnout are related to the work environment, modifying the environment to eliminate these factors has the potential for the most success. However, it is often difficult to change organizational structure, which means individuals must make changes themselves. When implemented appropriately, preven-
tion of burnout is easier and more cost-effective than resolving it once it has occurred; burnout that is addressed in later stages may take months or years to resolve fully [6; 9]. Thus, the primary goal is to stop the burnout cycle early by preventing the accumulation of stress. Early recognition of stress is key to prevention [85]. However, several issues create challenges for physicians to prevent stress and burnout: misinterpretation of their own well-being, reluctance to seek help, and disinclination to care for themselves as a priority. Although recognition of stress is important, physicians have been shown to inaccurately define their own well-being. Shanafelt et al. evaluated surgeons with the Mayo Clinic Physi- cian Well-Being Index and then asked the surgeons to subjec- tively assess their well-being relative to other physicians [86]. Approximately 89% of the surgeons said that their well-being was at or above average, but 71% of the surgeons who scored in the bottom 30% on the Index relative to national physician norms had said their well-being was at or above average. Many physicians do not seek help for stress or burnout because of the belief that these conditions are normal for the profes- sion, an attitude that begins in medical school, with students being advised to push through stress [20; 86]. This attitude leads physicians to believe that if they just work longer hours, the situation will resolve, but working longer hours only exacerbates stress and accelerates the burnout process. In addi- tion, not dealing with stress appropriately may lead to factors associated with stress, such as alcohol abuse, depression, and suicide ideation. Despite the high rates of these conditions, studies have shown that 33% to 60% of medical students and physicians are reluctant to seek help [27; 43; 77]. The reasons for the reluctance are concerns about their medical license, discrimination in hospital privileges and professional advance- ment, perceived stigma, and an inability to take time off from work [27; 43; 45; 87]. To help overcome these barriers, the Joint Commission issued guidelines mandating that medical staff “implement a process to identify and manage matters of individual health for licensed independent practitioners that is separate from actions taken for disciplinary purposes” [88].
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MDPA2126
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