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Feature
Physician Burnout:
Prevalence, Causes and Potential Solutions to Reclaim Joy and Meaning in Practice
By Dael Waxman, MD, Vice Chair of Professional Development,
Department of Family Medicine, Atrium Health
“I’m done,” said Meredith, a 47-year-old intensivist. “I just publication, books and articles in newspapers, magazines and on
don’t have the energy to be interested any longer. I am going the internet, have mushroomed. Workshops, seminars, retreats and
through the motions of looking like I care about my patients, conferences on physician burnout are burgeoning. While some authors
but it is getting harder to do. I don’t think I’m very good at this describe it as an epidemic, others have gone further and pronounced
burnout as endemic to modern health care.
anymore ... I better get out before I hurt someone.”
What’s going on?
At some point in training or practice, all health care professionals have
First, as with any occupation, physician burnout has always been with us.
experienced at least one of the feelings Meredith expresses. In most cases, it Christina Maslach, a leader in the field of occupational burnout and the
author of the gold standard survey to measure it, states burnout is the
is short-lived, perhaps only hours or days. When it is sustained over weeks result of a mismatch between personal factors an individual brings to the
workplace and the system factors in their chosen setting.3
and months, it is most likely burnout — a state of diminished emotional,
Personal factors include personality, values, motivation, training and
social, mental and physical capacity as a result of perceived demands on expectations. People who are selected for training in health professions
tend to have similar personal factors — perfectionism, self-directed
these energies. When present, it harms us, distresses our family members, learning, type-A personalities, a tendency toward compulsiveness and
they have a preference for working autonomously. All of these qualities
fractures relationships with teammates, disrupts systems of care and, most are reinforced in our training, as well. While these are valuable attributes
for this important work, disease processes are anything but predictable
important, can affect patient safety and clinical outcomes. and this results in a setup for most health professionals to self-blame
when things don’t go well medically. This takes a toll, and burnout
Burnout is almost twice as prevalent among physicians as workers in purely from personal factors can occur. Personal factor issues are why
burnout has always been present in our occupation.
other fields. In a landmark study published in 2012, Shanafelt showed
System factors include the work environment, team culture,
45 percent of physicians reported job expectations and all of the external forces that determine and
regulate what we do and how we do it. Contemporary health care has
at least one symptom of seen significant additions to workflow as a result of these external
forces. Performance measurement (quality, cost, patient satisfaction),
Burnout is almost burnout.1 When the study was implementation of electronic health records (with increased clerical
twice as prevalent burden), payor issues (coverage, prior authorization, formulary
among physicians repeated three years later, the changes) and efforts to improve efficiency (to make up for declining
reimbursement), have all unintentionally conspired to create a milieu that
prevalence had increased to 54 is an increasingly unfamiliar workspace for clinicians. This has led to an
percent.2 Coinciding with its often-heard refrain from today’s stressed physicians, “Why do I have to
do all of this stuff? I just want to take care of my patients!”
as workers in
other fields. Most authors and medical societies who have studied this area agree
that these system factors have caused the rise in the prevalence of
physician burnout in recent years.
What can be done about physician burnout?
As the antecedents to burnout are both personal and systemic,
interventions designed to improve both are necessary to reduce
burnout. A systematic review and meta-analysis of interventions,
published in The Lancet by West, et al in 2016 showed a 10 percent
overall reduction in burnout when personal factor interventions
(therapy, coaching, communication skills groups, mindfulness
6 | October 2018 • Mecklenburg Medicine
