Nearly half of all physicians describe themselves as burned out, according to a recent survey. The Medscape Physician Lifestyle Report, released earlier this year, found that 46% of all physicians were burned out, up substantially from 40% in 2013.
The specialties reporting the highest levels of burnout were critical care, at 53%, and emergency medicine, at 52%. Family and internal medicine were close behind at 50%. Specialties with the lowest burnout rate included dermatology at 37%, and psychiatry/mental health at 38%.
The survey defined burnout as a “loss of enthusiasm for work, feelings of cynicism and a low sense of personal accomplishment.” According to the study, multiple factors have contributed to growing disillusionment in medicine, including longer hours, lower income, excessive paperwork and increased computerization.
Michael Udwin, MD, executive director of physician engagement for McKesson, said physicians feel besieged by regulatory demands, growing workloads and declining reimbursements. Primary care doctors, in particular, he said, are concerned about increased competition from non-traditional retail clinics. Narrow payer networks favoring lower-cost providers also are creating angst across all specialties.
“I think a lot of expectations that people had when they went into medicine, in terms of independence and earning power, are proving more difficult to achieve and sustain today,” Dr. Udwin said.
Louis Wright, MD, a consultant with McKesson, said that “continual, erratic, non-predictive changes in payment policy” are proving problematic for physicians.
The American Medical Association (AMA) has warned that physician Medicare reimbursements could be cut by 13% over the next five years due to a “regulatory tsunami,” according to the Medscape survey. In addition, the survey states, an estimated 250,000 physicians and other providers will be penalized 1% of their Medicare payments this year for failing to achieve meaningful use of their electronic health record (EHR).
In face of tighter margins, independent practices face major difficulties keeping up with regulatory and technology demands. The result, Dr. Udwin said, is that a growing number are seeking the stability and support that employment can provide.
Between 2012 and 2013, solo practitioners decreased from 21% to 15% according to a 2013 survey by Jackson Healthcare. Over the same period of time, the percentage of doctors employed by hospitals jumped from 20% to 26%. The percentage of physicians with an ownership stake in their practice remained relatively stable at 22%-23%.1
Reversing the factors that are contributing to burnout will require change on a variety of fronts, according to Dr. Wright. He cited the absence of expert and informed medical guidance at the policy level as a major reason behind healthcare’s increasingly untenable paperwork demands.
“The system should recognize at some point that it would be much better served if physicians were in strategic, high-level positions, not necessarily making policy but informing policy,” he said. “Part of that is admittedly the fault of medicine, because physicians need to prepare themselves better to become engaged in high-level decisions.”
Dr. Wright added that adjusting work-life balance is essential to easing burnout. According to the Medscape Physician Lifestyle Report, research shows that being able to control work hours and schedule can play an important role in reducing stress, improving career satisfaction and reducing burnout. One study, the report stated, focused on improving resilience in physicians so they could more effectively balance and prioritize work and personal life. Physicians in the study reported that learning to set limits improved their sense of well-being and productivity.
“More than ever, we’ve got to adjust our expectations and understand that trade-offs have to be made between work and personal life,” Dr. Wright said.