The Physician Burnout Epidemic: What It Means for Patients and Reform

ELAINE SCHATTNER, August 22, 2012, The Atlantic

Almost half of U.S. physicians report at least one symptom of exhaustion or significant dissatisfaction. That has resonant implications across the national healthcare and economic discussions, as well as for patients.

In a large analysis published this week in Archives of Internal Medicine, researchers at the Mayo Clinic surveyed 7,288 physicians on their quality of life and job satisfaction. The results are striking — 46 percent of respondents reported at least one burnout symptom. The report indicates that doctors, as a group and relative to other highly educated individuals working similar hours, suffer high levels of emotional exhaustion and struggle to find a satisfying work-life balance.

“This matters not just for physicians, but for patients,” says Dr. Tait Shanafelt, a professor at the Mayo Clinic in Rochester, MN and senior author of the paper. Burnout can diminish professionalism and lessen the quality of care. At the same time, it leads doctors to reduce their hours and retire early. “We’re at the cusp of reform,” he said. “Precisely when we need more family and internal medicine doctors, students are more likely to enter other fields. This issue has implications for the adequacy of the physician workforce.”

“It’s a really big problem,” confirms Dr. Vineet Arora, a faculty member and associate residency program director at the University of Chicago. She has studied physician fatigue and professionalism. “The issues for doctors in training aren’t necessarily the same as for those who are in practice,” she says. After residency or fellowship, doctors are older and have less supervision. “There’s a recipe for burnout because of the long hours and high workload,” she says. “Most health care systems don’t provide joy and sustainability in the workplace,” she said. “In that case, it doesn’t matter happens during education and training. The delivery system has to change.”

The investigators used a standard evaluation tool called the Maslach Burnout Inventory to assess physicians’ wellbeing. As the authors acknowledge, one limitation to the study is the low response rate. Initially the investigators tried contacting nearly 90,000 physicians nationwide. Among those, 27,000 indicated they’d received an email. Among those doctors, only 7,288 – less than 10 percent of the original sample, or 27 percent of those who received the survey – completed the questionnaire. Although most of the doctors contacted did not complete the questionnaire, Shanafelt stands by the conclusions. “The surveyed sample was representative of the larger group initially contacted,” he said. The groups were similar in terms of the doctors’ age and gender, and how long they’d been out of medical school. “We didn’t just get extreme responses,” he adds. “We got the full spectrum – folks who are very satisfied, and very unsatisfied. There was a continuum.”

Burnout generally refers to a constellation of symptoms relating to behavior at the workplace. Symptoms include emotional fatigue, depersonalization, lost enthusiasm and a failed sense of personal accomplishment. Depersonalization — a tendency to treat people as objects, almost as a factory worker might perceive a task to be completed – happens most commonly in individuals whose work centers on interacting with others. “We know that those professionals at highest risk include teachers, social workers, police officers, nurses and physicians,” he said. Many experience feelings of burnout occasionally and to a varying degree, he said. “But when it happens a lot, there’s reason for concern.”


Perhaps the high rate of burnout is a result of the third party payment system creating an environment that is unfair to the physician. When a physician cannot run a viable practice financially it will obviously create a stressful environment, and is not beneficial to either the doctor or his patients. Why then have we allowed our doctors to be subjected to this type of market pressure? Most likely it is due to the power of the health care insurance lobby and the lack of a viable alternative to give the physicians and patients leverage to control their own paths. Concierge medicine offers one solution to the problem. A concierge doctor accepts direct payments from the patients and refuses health insurance influences. In exchange the concierge doctor and concierge medicine patient enter into an agreement for care which is focused on increased access to the doctor and personalized services not normally covered by health insurance. Basically the concierge doctor creates the perfect environment for  providing high quality care to the patient and protecting the practice. As patients look to find a concierge doctor in greater numbers, the ideals of quality care and happy doctors hopefully will find themselves back in style.

About Concierge Medicine Journal

Concierge Medicine Journal (CMJ) curates breaking concierge medicine news, and editorial opinion on a wide variety of topics relevant to the practice of Concierge Medicine.

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