Burnout in Physicians _ ______________________________________________________________________
sion and burnout have been high ( Table 7 ) [34; 40; 43; 49]. In another study, the rates of suicidal ideation and burnout were high among general internists (9% and 52%, respectively) [40]. REDUCING HOURS/LEAVING PRACTICE Burnout and dissatisfaction with work-life balance have been reported to be the strongest predictors of intent to reduce clinical work hours or leave the current position [58]. In a 2019 study, it was found that burnout in the form of physician turnover and fewer available clinic hours resulted in costs of approximately $4.6 billion [122]. A systematic review provided evidence that burnout is associated with decreased productiv- ity, defined as inability to work, increased number of sick days, and intent to leave practice or to change jobs [78]. Similarly, a review of physicians’ administrative/payroll records showed that burnout scores correlated with reductions in professional effort (measured in full-time equivalent units) over the subse- quent two years [79]. Specifically, the authors found that for each 1-point increase on the emotional exhaustion scale of the MBI, the likelihood of reducing work effort increased [79]. In one study, burned out physicians were significantly more likely than nonburned-out physicians to say that they intended to leave their practice within two years [29]. The authors of one study evaluated the number of years hos- pitalists intended to remain in practice in relation to risk of burnout; the percentage of hospitalists who intended to leave practice in less than four years ranged from 6.4% of those with no risk of burnout to 16.5% for those at risk for burnout to 44% for those who were burned out [80]. Another study was designed to evaluate burnout according to career stage; the physicians most likely to leave practice were those in middle- career, for whom rates of burnout were higher than for early- or late-career physicians. Approximately 12% of middle-career physicians said they planned to leave practice, compared with 5% of early- and late-career physicians [51]. The findings of all of these studies have implications for the supply of physicians, which is projected to fall short of the demand by 46,900 to 121,900 by the year 2032 [81].
FACTORS ASSOCIATED WITH BURNOUT Several studies have focused on the relationship between burnout and a variety of factors. The psychological factors of most concern for physicians are alcohol abuse/dependence, depression, and suicidal ideation ( Table 6 ) [43; 71; 72; 73; 74]. Patient care is also a primary concern, as the symptoms of burnout have been linked to suboptimal patient outcomes. ALCOHOL ABUSE/DEPENDENCE Among physicians, alcohol abuse/dependence has been sig- nificantly associated with the number of hours worked—a key cause of burnout—as well as with burnout itself [41; 43; 71; 72; 73]. Alcohol abuse/dependence is a substantial concern for physicians, as the rate reported in most studies has been much higher than that within the general population and is even higher among medical students [43; 71; 72; 73; 74]. In one study, burned out surgeons had a 25% increased risk of alcohol abuse or dependence [72]. However, in the 2015 Med- scape survey, alcohol abuse was not prevalent, with approxi- mately 50% of respondents reporting that they had less than one drink per day [47]. There was no difference in that study between physicians who were and were not burned out with regard to alcohol use [47]. In the 2019 Medscape survey, 23% of respondents reported drinking alcohol in order to cope with the effects of burnout [47]. DEPRESSION AND SUICIDAL IDEATION As with alcohol abuse, the rates of depression and suicidal ideation are substantially higher in physicians than within the general population [30; 36; 49; 75; 76]. Few studies have been done to evaluate the relationship between burnout and depression or suicidal ideation. In one study of attending and resident emergency medicine physicians, burnout was significantly associated with a positive screen for depression [28]. In another study, persistent burnout during residency was associated with screening positively for depression as an intern [35]. Burnout has also been independently associated with suicidal ideation among surgeons and medical students [33; 77]. However, the authors of most studies have gathered information on depression and burnout but have not analyzed the relationship. In most of these studies, rates of both depres-
PREVALENCE OF MENTAL HEALTH FACTORS IN PHYSICIANS AND MEDICAL STUDENTS/RESIDENTS VS. THE GENERAL POPULATION Factors Physicians General Population
Medical Students (MS) or Residents/Fellows (R/F)
Alcohol abuse/dependence
13% to 26%
32% (MS)
6%
Depression
18% to 40%
58% (MS) 17% to 48% (R/F)
6.6%
Suicidal ideation
5% to 9%
10% (MS)
3.7%
Source: [30; 36; 43; 49; 71; 72; 73; 74; 75; 76]
Table 6
75
MDPA2326
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