As the COVID-19 pandemic continues to overload hospitals and overwhelm healthcare staff across the nation [1], the epidemic of physician burnout continues to be overlooked. According to a Medscape survey on physicians conducted in 2020, 42% of physicians reported feeling burnt out last year [7] There are three cardinal signs of burnout: exhaustion, depersonalization, and lack of efficacy. As we continue to see physician burnout impair the delivery of quality care [6], we must research the foundations of burnout and consider why some specialties see much higher rates of burnout than others.
According to the Medscape survey conducted on over 15,000 physicians in over 29 specialties from last year, the specialties that have experienced the most burnout include urology (54%), neurology (50%), nephrology (49%), diabetes and endocrinology (46%), and family medicine (46%) [7]. According to this survey, when comparing burnout across generations, Generation X has the highest burnout rate at 48% when compared to millennials at 38% and boomers at 39% [7]. According to Carol Bernstein, MD (vice chair for faculty development and well-being at Montefiore Medical Center), this burnout distribution in generations is understandable because physicians in Generation X are at this time experiencing mid-career burnouts, “juggling multiple roles outside of work, including caring for children as well as elderly parents and working as well as planning for retirement.” When addressing gender differences of physician burnout, women are much more likely to experience burnout, with 48% of sampled women reporting burnout compared to 37% of sampled men reporting burnout [7]. According to Halee Fischer-Wright (MD, CEO of the Medical Group Management Association), women “take on more ‘non-promotable’ work and they carry more of the weight in collaborative work.”
Burnout can be attributed to many different factors, including excessive bureaucratic tasks (administrative paperwork, filing insurance claims, etc.), working too many hours, and a lack of collaboration within the healthcare setting [3]. These ideas will be addressed with regard to different specialties, and these findings will be compared to salary, average number of hours worked per week, and other indicators of job satisfaction by specialty.
According to the Medscape survey, 35% responded to the question “What would reduce your burnout?” with “increased compensation to reduce financial stress” [7]. Financial stress, although a relatively taboo discussion among a profession meant to help others, should be discussed in terms of physician burnout and financial compensation. The average medical school debt is $215,900, which excludes undergraduate and other educational debts [5]. Often, medical students choose specialties based on salary in light of their accumulating medical school debt, among other factors such as work-life balance. As a result, these individuals are entering a specialty that they may not be fully passionate about and are facing the risk of a rapidly evolving profession where financial compensation may change significantly. Physicians may be financially strained and face higher resulting stresses at home, which may be reduced through higher salaries [8]. Mantri et. al discusses the efficacy of financial resources to “hire help with chores”, and subsequently giving physicians more leisure activities that decreases the probability of burnout [8].
Although many of the specialties that experience the highest burnout rates have also some of the highest average annual physician compensation (e.g. urology annual salary: $427,000), others have some of the lowest average annual physician compensation (e.g. family medicine: $236,000) [9]. Practicing urologists in the United States work a median of 56 hours in a “typical” week [4]. Practicing family physicians work approximately, on average, 50 hours per week. On the other hand, dermatologists, which have a significantly lower burnout rate and higher salary than most specialties, work on average 30-40 hours per week. The average salary for dermatologists in the same Medscape? survey was $394,000 per year [9]. Many factors, including amount of hours worked per week, financial compensation through annual salary, and more qualitative measures such as practicing setting and amount of stress experienced are correlated with increased burnout rates for varying specialties. According to Franc-Guidmond et. al, dealing with burnout not only lies with the affected individual “but also in the capable hands of their physician leaders” and their institutions [4].
Burnout affects virtually all aspects of a physician’s capability of delivering care. The excessive amounts of administrative work and other stressful conditions lead physicians to feel a lack of control over their professions. One of the largest reasons for such feelings of burnout is the lack of financial resources for physicians. Large amounts of medical debt, among other reasons such as the inability to balance work and leisure at home, prevent physicians from feeling happy. These patterns are substantiated across multiple studies surveying physicians across different specialties. Although these burnout rates are not directly correlated to job satisfaction markers such as salary and/or average hours worked, we need to further investigate the root of these high burnout rates in specific specialties and attempt to alleviate this to maximize the delivery of quality care by healthcare professionals while also considering the well-being of these workers.
References:
Abelson, R. (2020, November 27). Covid overload: U.S. hospitals are ... - The New York Times. The New York Times. Retrieved December 2, 2021, from https://www.nytimes.com/2020/11/27/health/covid-hospitals-overload.html.
Berg, S. (2020, January 21). Physician burnout: Which medical specialties feel the most stress. American Medical Association. Retrieved November 16, 2021, from https://www.ama-assn.org/practice-management/physician-health/physician-burnout-which-medical-specialties-feel-most-stress.
Drummond, D. (2015, October 1). Physician burnout: Its origin, symptoms, and five main causes. Family Practice Management. Retrieved November 16, 2021, from https://www.aafp.org/fpm/2015/0900/p42.html.
Franc-Guimond, J., Mcneil, B., Schlossberg, S. M., North, A. C., & Sener, A. (2018, April). Urologist burnout: Frequency, causes, and potential solutions to an unspoken entity. Canadian Urological Association journal = Journal de l'Association des urologues du Canada. Retrieved November 16, 2021, from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5905543/
Hanson, M. (2021, July 25). Average medical school debt [2021]: Student loan statistics. Education Data Initiative. Retrieved November 16, 2021, from https://educationdata.org/average-medical-school-debt#:~:text=The%20average%20medical%20school%20debt,school%20graduates%20have%20educational%20debt.
Health, S. (2019, August 2). How does provider Burnout Impact Patient Care Quality, care access?Se. PatientEngagementHIT. Retrieved December 2, 2021, from https://patientengagementhit.com/news/how-does-provider-burnout-impact-patient-care-quality-care-access.
Kane, L. (2021, January 15). Medscape National Physician Burnout & Suicide Report 2020: The generational divide. Medscape. Retrieved November 16, 2021, from https://www.medscape.com/slideshow/2020-lifestyle-burnout-6012460?faf=1#10.
Mantri, S., Spector, A., & Husseini, N. (2020, December 31). How compensation can affect physician burnout. KevinMD.com. Retrieved November 16, 2021, from https://www.kevinmd.com/blog/2019/11/how-compensation-can-affect-physician-burnout.html.
Wilcox, L. (2021, May 26). Physician salary report 2021: Doctor's compensation steady. Weatherby Blog. Retrieved November 16, 2021, from https://weatherbyhealthcare.com/blog/annual-physician-salary-report.
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