I recently came across Medscape’s 2019 iteration of its “National Physician Burnout, Depression & Suicide Report.” As in prior years, the results were thoroughly disheartening.
The annual exercise surveyed 15,069 physicians across 29 specialties to quantify rates of burnout, depression, and suicidal ideation amongst physicians. This year, 44 percent of respondents reported being burned out, up from 42 percent last year. Notably, women (50 percent) were more likely to report being burned out than men (39 percent).
Rates of burnout were not equal across all fields. Urologists, neurologists, and physical medicine and rehabilitation physicians reported the highest rates of burnout, at 54 percent, 53 percent, and 52 percent, respectively. On the other hand, public health and preventative medicine physicians, nephrologists, and pathologists reported the lowest rates of burnout at 28 percent, 32 percent, and 33 percent, respectively. Of the 29 fields surveyed, 17 had reported burnout rates over 40 percent.
When asked what they believed contributed most to their burnout, it could be broken down into the following:
- About half (59 percent) cited too many bureaucratic tasks (like charting and paperwork);
- A third (34 percent) cited spending too many hours at work;
- A third (32 percent) cited the increased computerization of medical practice; and
- Close to a third (30 percent) reported a lack of respect from administrators or colleagues.
Unsurprisingly, the more a physician worked per week, the higher the risk of burnout: Just over a third (36 percent) of physicians who worked 31-40 hours per week reported being burned out versus more than half (57 percent) of those who worked 71 or more hours per week.
Interestingly, rates of burnout did not differ significantly by where a physician worked. Of those in office-based solo practices—where physicians ostensibly enjoy greater degrees of freedom—41 percent reported being burned out, which is comparable to those who work in hospitals who reported burnout (44 percent), and those who work in health care organizations (49 percent).
While many physicians reported using positive coping strategies, like exercise, to deal with burnout, significant minorities reported using more destructive methods: 4 percent reported isolating themselves from others; 23 percent reported drinking alcohol; 3 percent reported smoking; and 2 percent reported using prescription drugs.
In addition, a number of respondents (15 percent) reported being depressed, with about half (53 percent) of these individuals admitting that their depression affected patient care, and nearly two-thirds said that it affected their workplace behavior.
Finally, 14 percent reported thoughts of suicide, while 1 percent reported having attempted suicide. Still, 42 percent of those with thoughts of suicide did not tell anyone about them, and 64 percent did not and did not intend to seek care for their burnout or depression.
At first glance, I was not quite sure what to make of this report. The statistics were obviously alarming, but they were largely in line with other results I had come across in the past. And they seemed to match up with what I have observed in my own career. I was numbed to their significance.
On further reflection, however, I became profoundly disappointed. Hardly a day passes where a new article is not posted on KevinMD or Op-Med that details the troubling consequences of physician burnout. And in recent years, the existence and consequences of physician burnout have become so well-known that the topic has moved to the mainstream, with large media organizations like The Atlantic and The New York Times reporting on the topic. Yet, despite all of the progress in generating greater awareness on the issue, this Medscape report makes clear just how little progress we have made in actually improving the lives of physicians. That, simply put, is an American tragedy.
And it is a tragedy with profound consequences. As the survey indicates, for physicians, burnout jeopardizes their quality of life, can affect their ability to care for patients and puts them at risk of depression and suicide. For patients, physician burnout can be dangerous, as burned out physicians are more likely to commit medical errors. Given these risks, society has clear incentives to take steps to reduce physician burnout.
However, society has had these same incentives for years, if not decades. And as this report makes clear, rates of physician burnout have not been improving over the past decade. In fact, they may be getting worse.
There are many reasons for this, as the report makes abundantly clear. But at the end of the day, these results represent a failure of both society and the medical establishment to get ahold of the crisis. They have not shown any willingness to take the steps necessary to fundamentally improve the work lives of physicians, like rethinking electronic medical records and the patient-provider interaction, reducing long work hours, and changing the culture of American medicine.
Accomplishing any of goals, let alone all three, is, of course, a huge challenge. But with the burnout crisis intensifying every year, action is urgently needed. Lives literally depend on it.
Dr. Kunal Sindhu is a resident physician in New York City and a 2018-2019 Doximity Author. You can follow him on Twitter @sindhu_kunal.
Illustration by April Brust