By Scott Baltic
NEW YORK—At a large U.S. nonprofit academic medical center, one-third of physicians met criteria for burnout, a cross-sectional study found.
In all, 1,528 physicians at the Cleveland Clinic Health System were surveyed with the medical personnel version of the Maslach Burnout Inventory. Of the 1,145 respondents (mean age, 50), 399 (35%) had scores indicating overall burnout.
About 38% of the respondents were in internal or family medicine, with the rest spread among 11 specialties, according to the February 19 online report in JAMA Internal Medicine.
Burnout was associated with increased odds of leaving the organization (indicated by the inventory’s “emotional exhaustion” subscale) and of ombudsman complaints (“depersonalization” subscale).
Non-white physicians were less likely than white physicians to meet criteria for overall burnout. Overall burnout also was more common among physicians with full-time-equivalent status, as was emotional exhaustion. Male physicians, on average, scored higher than female physicians on depersonalization.
Having more than 20 years in medical practice was associated with less risk of emotional exhaustion. Higher patient satisfaction with primary care physician (PCP) communication was associated with greater emotional exhaustion.
Physician marital status, having children under 18 living in the home, and number of vacation days did not show an association with burnout.
“Physicians who give more to patients during clinical encounters may find themselves emotionally depleted,” the authors write. “(R)outine assessment of burnout by health care organizations is warranted to identify the need for additional individual and organizational support.”
The 35% burnout rate among respondents was “pretty similar to other institutions measured at or around the same time frame, if not a bit lower,” first author Dr. Amy K. Windover of the Cleveland Clinic told Reuters Health by email. “While the prevalence was equivalent to or even lower than other institutions, it signals the need for systemic change in the healthcare industry.”
Dr. Colin P. West, of Mayo Clinic in Rochester, Minnesota, told Reuters Health by email that these results “generally align with what we have learned from previous studies of physician burnout, including the impact of burnout on turnover.”
The finding that high emotional exhaustion levels is associated with higher patient satisfaction with PCP communication, Dr. West said, “is consistent with the theory that physicians who invest the most in their patients’ care may paradoxically be more prone to burnout. . . . High patient satisfaction scores do not mean burnout is absent.”
Dr. Tait Shanafelt, chief wellness officer at the Stanford University School of Medicine in California, told Reuters Health by phone that this study provides some “new observations” about physician burnout, including the fact that time spent in clinical care may be the most important factor.
If the most-dedicated physicians are at greatest risk of burnout, he noted, physicians may paradoxically have to limit the time they spend “being a doctor” day-to-day to maintain their endurance for the longer term.
It’s crucial to be precise when talking about “clinical medicine,” explained Dr. Shanafelt. The term can refer narrowly to direct patient care or apply more broadly to include the administrative tasks that accompany it. He specifically cited a 2016 study that found, overall, physicians spend an average of only 27% of their day on direct “face time” with patients - and 49% on clerical work.
This imbalance, Dr. Shanafelt said, can be countered in part by reducing physicians’ clerical workload and enhancing team-based care.
Neither Dr. West nor Dr. Shanafelt was connected to the Cleveland Clinic study.
JAMA Intern Med 2018.
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