Tens (or hundreds) of thousands of Americans die each year as a result of preventable medical errors. Changes in the practice and business of medicine have caused some to question whether burnout among physicians and other healthcare providers may adversely affect patient outcomes. A clear consensus supports the contention that burnout affects patients, albeit with low-quality objective data. The psychological and physical impact on physicians and other providers is quite clear, however, and the impact on the physician workforce (where large shortages are projected) is yet another cause for concern. We have all heard the airplane safety announcement remind us to “Please put on your own oxygen mask first before assisting others.” Unfortunately, like many airline passengers (very few of whom use oxygen masks correctly when they are needed), physicians often do not recognize symptoms of burnout or depression, and even less often do they seek help. We detail the causes and consequences of physician burnout and propose solutions to increase physician work satisfaction.
Scope and Impact of Physician Burnout
Research regarding physician burnout is plagued by large variability in reported prevalence rates and a lack of agreed terminology (a review of 182 studies found at least 142 unique definitions).1 Most authors suggest a prevalence rate of approximately half; twice that of the general working population in the United States and with an estimated cost of roughly $5 billion per year related to reduced clinical productivity and increased physician turnover.2 Some believe the condition to manifest at some level in nearly all physicians.3
The burned-out physician “is angry, irritable, impatient, has increased absenteeism, decreased productivity and decreased quality of care.” Evidence of burnout was found in 42% of 15,000 US physicians who responded to a 2018 online survey. The greatest incidence of burnout (50%) was among physicians 45-54 years old, the age group in which work productivity should peak and practices should be economically stable.4 Repeated in 2019, the findings were similar, with an overall 44% rate of “feeling burned out,” and an alarming 14% reporting suicidal thoughts. Of those experiencing suicidal thoughts, only one-third sought treatment.5 Compared with doctoral-level professionals in other fields, physicians work more long hours, are less satisfied with the balance between their professional and personal lives, and experience symptoms of burnout at significantly higher rates.6
Burnout is associated with an increased risk of major medical errors.7 A recent meta-analysis of 47 studies involving more than 42,000 physicians found that physician burnout doubled the risk of adverse patient safety incidents and led to poorer overall quality of care and decreased patient satisfaction.8 Physicians reporting burnout symptoms work fewer hours and leave clinical medicine at a higher rate than do those not affected.9 Burnout among primary care physicians also increases turnover, and therefore costs.10 Physician burnout and the resultant decreased productivity may exacerbate the previously predicted shortfall of 45,000 to 90,000 physicians in the United States by 2025.11
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-Scott W. Yates, MD, MBA, MS, FACP
