________________________________________________________________________ Burnout in Physicians
RATES OF DEPRESSION AND BURNOUT BY SPECIALTY AREA OR STAGE OF CAREER
Subjects
Rate of Depression
Rate of Burnout
Gynecologic oncologists
33%
32%
General internists
40%
53%
Surgeons
30%
40%
Early-career physicians
40%
51%
Residents/fellows
51%
60%
Medical students
58%
56%
Source: [34; 40; 43; 49]
Table 7
PATIENT SAFETY, QUALITY OF CARE, AND PATIENT SATISFACTION Studies have also addressed the effect of physician burnout on medical errors, quality of care, and patient satisfaction [118]. One of the first of these studies involved internal medicine residents who were surveyed with the MBI and asked to respond to five statements regarding suboptimal care (e.g., “I did not fully discuss treatment options or answer a patient’s questions” or “I made…errors that were not due to a lack of knowledge or inexperience”) [32]. Approximately 53% of burned out residents self-reported suboptimal care compared with 21% of nonburned-out residents. In multivariate analyses, burnout was strongly associated with self-report of suboptimal care at least monthly. The authors also evaluated each domain of burnout and found that only a high score on the deper- sonalization domain was associated with suboptimal care. An association between high burnout scores and self-reports of suboptimal care and of medical errors was also found in later studies involving residents [41; 82]. In one of these studies, self-reported medical errors and scores for best practices (fol- lowing principles identified as best practices in anesthesiology) were significantly associated with high risk of burnout among anesthesiology residents [41]. The median best practice score was significantly lower for residents at high risk of burnout than for residents at low risk. In addition, significantly more residents at high risk for both burnout and depression reported multiple medical errors within the previous year compared with residents at low risk (33% vs. 0.7%) [41]. Burnout was also associated with self-reports of suboptimal care in a study of emergency medicine physicians and residents. The authors completed a burnout evaluation and asked six questions to assess suboptimal care; physicians who had high burnout scores were more likely to report all six acts of subop- timal care [28]. In another study, reporting a major medical error during the last three months was significantly associated with burnout among surgeons [83]. The depersonalization domain had the most effect; for each 1-point increase in the score in this domain, there was an 11% increase in the likeli- hood of reporting an error, and for each 1-point increase in the score on the emotional exhaustion scale, there was a 5% increase in likelihood. In multivariate analysis that controlled for other personal and professional factors, burnout was an
independent predictor of reporting a major medical error. In contrast to these findings, studies of family physicians and general internists have shown no consistent relationships between burnout, medical errors, and quality of care [29; 54]. With regard to patient satisfaction, a preliminary study involved a survey of 178 matched pairs of physicians and patients who had been hospitalized in the previous year. The authors found that a high score on the depersonalization domain was associ- ated with lower rate of patient satisfaction and longer recovery after hospital discharge (after controlling for factors such as severity of illness) [84]. STRATEGIES TO PREVENT AND COPE WITH STRESS AND BURNOUT There are two primary approaches to preventing and/or coping with stress and burnout. Given that the most significant factors in burnout are related to the work environment, modifying the environment to eliminate these factors has the potential for the most success. However, it is often difficult to change organizational structure, which means individuals must make changes themselves. When implemented appropriately, preven- tion of burnout is easier and more cost-effective than resolving it once it has occurred; burnout that is addressed in later stages may take months or years to resolve fully [6; 9]. Thus, the primary goal is to stop the burnout cycle early by preventing the accumulation of stress. Early recognition of stress is key to prevention [85]. However, several issues create challenges for physicians to prevent stress and burnout: misinterpretation of their own well-being, reluctance to seek help, and disinclination to care for themselves as a priority. Although recognition of stress is important, physicians have been shown to inaccurately define their own well-being. Shanafelt et al. evaluated surgeons with the Mayo Clinic Physi- cian Well-Being Index and then asked the surgeons to subjec- tively assess their well-being relative to other physicians [86]. Approximately 89% of the surgeons said that their well-being was at or above average, but 71% of the surgeons who scored in the bottom 30% on the Index relative to national physician norms had said their well-being was at or above average.
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MDPA2326
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