Overwork remains a persistent problem for the health care workforce, affecting 86% of clinicians, according to a recent Doximity poll. That figure is a 12% leap from the 74% of clinicians who reported feeling overworked in May 2021, a year into the COVID-19 pandemic.
The latest Doximity poll, conducted between October 2022 and January 2023, includes the responses of 2,851 physicians, pharmacists, and APPs.
The vast majority of clinicians in each profession agree they are overworked: 86% of physicians, 87% of NPs and CRNAs, 88% of PAs, and 88% of pharmacists. As a result, 66% of clinicians who responded to the poll are considering changing their career plans, compared with roughly 50% of clinicians in 2021.
The poll responses indicate that overwork is widespread, regardless of a clinician’s age, gender, specialty, or geographic region. For example, 85% of clinicians in the South, 87% in the Midwest, 87% in the West, and 88% in the Northeast report feeling overworked.
Clinicians report feeling increasingly strained as they age: 71% of clinicians in their 20s say they are overworked, and the figure steadily rises for those in their 30s (85%), 40s (87%), and 50s (89%), dipping slightly for those approaching retirement in their 60s (88%) and 70+ (81%).
What’s more, a higher percentage of women (91%) than men (83%) report overwork, which corroborates a long list of studies showing disproportionately higher rates of burnout in women than men. A JAMA study found that, from 2001 to 2021, physician mothers were the only subgroup among practicing physicians to have a statistically significant increase in work hours (3%), while work hours for physicians overall decreased by 7.6% during that period.
In response to feeling overworked, more than a third of women (34%) and men (36%) are considering early retirement, based on the poll results. In addition, women (22%) are more likely than men (13%) to look for another employer. One possible explanation for these trends: Medicine’s highest-paid surgical specialties skew toward men, which may make early retirement more feasible, while women may feel greater financial pressure to re-enter the workforce.
For physicians, a higher percentage of those in primary care report feeling overworked (92%) than surgeons (84%) and specialists (84%). Several organizations have said that growing concern over burnout has exacerbated the impending physician shortage, especially among PCPs, pushing it toward “crisis proportions.”
“I changed subspecialties from primary care to hospice/palliative care because my life had become miserable and unlivable,” said Dr. James Long, who currently practices in Kentucky. “I still work 50 hours a week plus lots of call, but … I actually get to be a doctor again rather than a data entry specialist. Hard work was never the issue; work with no end nor reward was.”
An Ongoing Issue
The uptick in overwork may signal a continuation of unease among clinicians beyond early stressors from the pandemic. Ongoing concerns, such as health care consolidation and inflation outpacing salary growth, may be contributing factors. It may also suggest that current efforts to address concerns over emotional exhaustion or work detachment may not be entirely sufficient.
“I think that the basic issues are the deprofessionalization of medicine, and the pressure to provide lower and lower cost services,” said Dr. Marc Webb, who runs a surgical practice in Michigan. “We have slowly become ‘providers’ rather than physicians, and employees rather than autonomous actors. … We have become ‘labor,’ and as in every industry in the U.S. today, we are being squeezed to do more for less by management and seem to have little recourse.”
A number of clinicians have turned to individual efforts, such as mindfulness courses and unpaid leave, to address burnout and other consequences of overwork.
Others, offering a shift in strategy, have underscored the need for change on a systems level rather than focusing on individual wellness. This approach includes improvements such as reducing administrative burden, providing adequate staffing, adjusting sick-leave and compensation policies, and efforts around physician unionization and physician advocacy.
Still other clinicians are pursuing a more independent path through private practice.
“I have avoided burnout by being self-employed in solo private practice,” said Dr. Bettina Franz, a psychiatrist based in California. “I am totally in control of my own schedule. This is unfortunately not a model that works for most physicians, and I feel extraordinarily lucky to be able to practice this way.”
Regardless of their preferred approach, many clinicians, including family physician Dr. David Crimin, have emphasized the importance of actively advocating for their patients and profession on a community, state, and national level. In addition to his clinical work in rural Utah, Dr. Crimin educates medical students and trainees on self-advocacy as an assistant professor.
“We teach physicians to advocate for their patients (and rightly so), but we are poor advocates for ourselves and our profession,” he said. “Like the old saying goes, ‘If you do not have a seat at the table, you will be part of the menu.’”