Over 50% of US Physicians now suffering at least one symptom of burnout. Depression and suicidal ideation rates even more concerning.
For a while now I have been suspicious that physician burnout rates are increasing here in the USA, especially in the last five years or so. There is just too much political chaos, marketplace M&A activity and documentation overload for it to be otherwise.
Finally the research has caught up with this suspicion in the latest version of Mayo’s landmark 2011 physician burnout study. Here is our smoking gun at last. Unfortunately the numbers are bad and the burnout numbers, though mind boggling, are not the most concerning finding.
Mayo Clinic Proceedings this month published results of round two of their survey of burnout in physicians compared to burnout in the “normal population”. The first round in 2011 was major news across the country and the first study that compared physician burnout rates to those of non-physician workers.
The burnout rates are what I expected. The shocker is the number of physicians screening positive for depression and suicidal ideation that no one is reporting on.
The headline trends are these
From 2011 to 2014 physician burnout rates in US physicians increased
AND the gap between physician burnout rates and burnout rates in the normal population widened
The headline stats are these
54.4% of physicians admit to at least one symptom of burnout in 2014 up from 45.5% in 2011 – a 19.5% increase. The Maslach Burnout Inventory was used to measure burnout in both groups. The physician burnout symptom that was the most common is emotional exhaustion.
Burnout in the “normal population” stayed steady over that time period at about 25%. The odds ratio shows physicians are 1.97 times more likely to suffer from burnout than the normal population
What failed to gain any attention is that 39% of the physicians screened positive for depression. I think this slipped under the radar because this rate did not change between the studies. You have to dig deeper into the report to find this statistic.
The rate of suicidal ideation among the physicians jumped from 4.0 – 7.2%.That is an 80% increase. The survey question was about suicidal ideation in the previous year. 7.2% of physicians had thought about suicide. This is the shocker of the report for me.
Work Life Balance continues to worsen
When the survey tossed out the sentence, “My work schedule leaves me enough time for my personal and/or family life” here are the physician numbers who responded with either “disagree” or “strongly disagree”:
2011 – 37.1%
2014 – 44.5%
Again, a 20% increase over 2011
[ Download a PDF of the full study here ]
A database of 94,032 physicians was assembled via the American Medical Association Physician Master File. Physician Burnout surveys were delivered by email in August of 2014 with three reminder emails delivered over the ensuing 6 weeks.
35,922 physicians who opened at least 1 invitation e-mail were considered to have received the invitation to participate in the study.
Of those, 6880 or 19.2% filled out the survey
This 20% response rate is average is normal for surveys of this type. There is no data on how the non-responding 80% would have filled out the survey. All we know is this population of responders is a statistically valid sample of the larger population with regards to demographics.
They surveyed a database of 5392 employed individuals ages 35-65 maintained by the Knowledge Panel whose website is here.
Both populations were screened for
Depression and suicidal ideation
Satisfaction with work-life balance
Take home points
From my work with thousands of burned out physicians and dozens of the organizations that employ them, here is what I take from the study.
Physician burnout is bad and getting slowly worse
The burnout prevalence in YOUR ORGANIZATION is probably right around 50% too – no matter how much you might wish that were not true. Unless you have a proactive, system-wide burnout prevention program in place your burnout rate may actually be higher than this.
It does not have to be this way. Here at TheHappyMD.com we have experience with hundreds of physicians in all specialties showing that simple changes in awareness and new actions applied over time can reverse and prevent burnout. There is no rocket science or black box of mystery here. We need to fill in the holes in our medical education and be actively involved in building a less stressful workplace.
Suicidal ideation is surprisingly common – THAT is the scary statistic here.This is why we always recommend a 24/7 physician crisis hotline and a proactive crisis intervention program for all organizations that employ physicians. This service must be well promoted and highly visible in order to garner participation from the doctors.
Despite the constant presence of burnout concerns in the healthcare industry and the exploding popularity of the topic of physician burnout – effective prevention tools are not being disseminate widely enough to effect the trend of increasing physician burnout rates.
We here at TheHappyMD.com have not reached nearly enough doctors yet with our tools to prevent physician burnout. Not by any means. Here is our Mission.
This level of physician burnout interferes with our ability to offer quality of care, however that is not my main concern as a change agent. My concern is this level of burnout makes it extremely challenging for doctors to pull their heads up and play a meaningful role in the redesign of the workplace necessary to reverse this trend.
Continued prevalence studies are meaningless here. Please stop! It is time for action to treat and prevent physician burnout, rather than continue to run simple studies like this to pad your bibliography. Sheesh. I wish the academics would do the hard work of measuring effectiveness of prevention efforts with the same vigor as they complete these simple survey studies.
Dike Drummond MD is a family physician and CEO of TheHappyMD.com providing coaching, training and consulting to prevent physician burnout. Find over 117 ways to decrease physician stress and build life balance at www.TheHappyMD.com
This data isn’t any news. The number of physicians suffering from burnout and suicide idealization doesn’t surprise anyone, it is common sense. We have this odd need as a society of patients to believe that physicians are more than human, but working 70-80 hour weeks and having to deal with layers of bureaucracy, expectations, and the most intimate problems of hundreds of patients doesn’t help anyone’s wellness. Add to this the crippling debt (medical school costs continue to rise) and the years of study and preparation to even make it to a hospital, this shouldn’t be surprising in the least. Until this god complex (both internal and external pressure to be perfect) is gone and we see healthcare workers for what they are, people providing a very important service, then these numbers will continue to increase. Having a good, well-adjusted physician is important to a decrease of medical errors and physician burnout.
Am not surprised. I happen to be one of those nasty “mids” that one of your respondents mentioned. Let me tell you my story. I have practiced IM for 26 years in both the civilian and military sectors. Up until several years ago, when utilizing those “horrid” paper charts, I pretty much enjoyed a 45 hr work week on average (not including random twice weekly calls). With the onset of EHR, my “work week” is between 65-70 hrs weekly. The docs in the practice have noticed similar increases so it’s not “all about me”. Because of my being away from homelife and wife….my marriage deteriorated and am now in that twilight zone of separation/divorce due in large part to my NOT being at home…yet…I STILL need to maintain a fucking livelihood to ensure that everyone else (wife/kids) is properly cared for financially. Plus…I happen to be a nice guy and patients oddly seem to like me and trust me and seek out my consult. So….in the meantime, I happen to meet a wonderful woman/girlfriend who after several months is ALSO not too pleased with the amount of hours spent away from her DUE TO the fucking EHR requirements/MU/ evidence-based horseshit “metrics”/yadda yadda yadda. I personally CAN NOT seem to fucking win (by the way I don’t give a shit about using the f-bombs here). So…am I angry? Gee…hmmm…gosh that’s a tough one. Can I appreciate that there are fellow practitioners out there that contemplate suicide? Sure. I am 57 and I think I can make it ’til 62 at which time I will GLADLY take my SS payments and get the fuck out of medicine (I actually used to enjoy coming to work, but no more)….5 more years is the only reason that I have decided to not blow my fucking brains out.
“I happen to be a nice guy.”
When my friend Jack Cochran was leader of Permanente medical group in Colorado some years ago, he found that the 500 physicians within the group were badly burned out. He declared that his mission was to do whatever he could to preserve and enhance physician careers. He did a lot of things: Paid primary care docs more, set clear standards, measured things that were clearly measurable, established a review process where docs having trouble received support and training, etc. Jack recognized that his patients needed physicians who were engaged in doing meaningful, enjoyable work. We are playing a vy dangerous game with our physicians these days. The big squeeze from payers, administrators, and regulators, the tyranny of the EHR, of ever-shifting metrics, of constant change in the delivery system, has made life miserable for too many good doctors. At the IHI forum last week Jack and I talked about this issue and this post from Dike is further evidence of the urgent nature of the problem. What is particularly frustrating to me is that there are a number of places around the country taking on this issue with some success. The flow in primary care work at Virginia Mason, for example, is a significant stress reducer for physicians. There are enough good ideas out there that if we worked to identify a best-practice approach to preserving and enhancing physician careers we could make meaningful progress. This issue is just as important as the safety issue was back in 199 when the IOM issued To Err Is Human. Somebody — why not the IOM? — needs to pull together a bast-practice report and get it endorsed and circulated. Preferably sooner rather than later.
“the tyranny of the EHR”
Given that we are NOT going back to paper, how do we fix that? I’ve been writing about it here:
“What would significantly patient care-enhancing Health IT look like? Will all of the powerful entrenched secondary and tertiary “stakeholders” comprising the documentation tail continue to wag the HIT dog?”
BTW, I’ve cited Dr. Cochrane’s book “The Doctor Crisis” before too.
The solution is simple (re the tyranny of the EHR)…albeit politically daunting: repeal Hitech/CMS mandates, inducements, subsidies, penalties related to EHRs. That way purveyors would launch hundreds of revisions and features to make their product attractive to physicians and patients and hospital administrators (some would work, some would fall away…that is the way technological innovation always works)…..on their own merits, not on the basis of meeting some far removed govt bureaucrat or think tank expert mandate based on their untested vision of what should be good….been there, done that and it is a disaster.
What do you think is the likelihood of HITECH/MU repeal? IMO, it won’t even be on the table until January 2017 at the earliest.
Moreover, re “far removed govt bureaucrat or think tank expert”
From my blog post:
“OK, but, having worked in the Meaningful Use program at one of the RECs (wherein I routinely bit the sometimes bozo hand that fed me), I can only note with confidence that everyone had substantive input on the MU regs at every step. The public review and comment repositories routinely overflowed with thousands of recommendations (even after culling the Kenyan Commie Obama Healthcare Dictatorship ones), many of them written by physicians working daily in the clinical trenches. Rational and practicable recommendations got incorporated. ONC and CMS listened. And, repeating thoughts from my last post,
… surveying docs as to their opinions on documentation and digital decision support can be done, and has been done, repeatedly. As with nearly all opinion polling, you get wide distributions of sentiment pro and con. Moreover, all of this latest naysaying misses one fundamental point. It’s not about information technology per se, it’s the “productivity treadmill” imperative. If the typical physician only had to see an average of one patient per hour (8-10 pts per day) rather than 25-30, adequate documentation would be way less onerous. Let the mids handle the banal cases.
Unless you’re really arguing that physicians should be absolved from any documentation duties whatsoever.
What proportion of patient encounter bookings requiring MD attention are scheduled mainly to keep the doors open? By some credible estimates it’s more than half…”
Agreed, January 2017 at the earliest….and even if Republicans win not clear it will happen.
Yes, I am sure many professionals tried to get input to incorporate good sounding ideas and reject/fend off bad ones. But the real key is to roll back the coercion to induce system-wide adoption of a standardized technology not ready for prime time. There is an increasing consensus that even with the efforts to make EHRs useful the net effect has been very expensive and damaging in many ways, among them physician burnout…..overwhelming any positives….so far.
As an aside see the 12/15/15 Wall Street Journal piece (Personal Journal section) on how EHRs have resulted in physicians seldom looking at patients during meetings….they stare at the screen…..and the impact of this on patients.