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September 24, 2018

Confused by what physician 'burnout' really means? You aren't alone, a JAMA study reveals.

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    Nearly half of second-year resident physicians are burned out, according to a JAMA study published last week—but what exactly does "burnout" mean? There's not a clear definition, according to a separate JAMA study published in the same issue.  

    Mitigate physician burnout with these 4 key strategies

    Burnout is common among second-year residents, study finds

    For the first study, researchers followed a group of new doctors from their fourth year of medical school to their second year of residency.

    Researchers recorded participants' "symptoms of burnout," which researchers gauged by asking participants the extent to which they agree with two statements: "I feel burned out from my work," and "I've become more callous toward people since I started this job."  

    The questions were intended to capture two of the three symptoms of the classic definition of burnout: exhaustion and feelings of depersonalization. (The third classic symptom is low sense of personal accomplishment.)

    Of the 3,588 second-year resident physicians who filled out the final study questionnaire, 45% reported feeling symptoms of burnout at least weekly. Physicians trained in urology, neurology, and emergency medicine displayed higher risk, the authors said. The study found 14% of residents said they regretted their career choice.

    But what exactly is burnout? Researchers haven't settled on an answer.

    But the second JAMA study reveals that, even though a significant body of research has been published on "burnout," many of those studies used varying definitions of the term—which makes complicates efforts to draw conclusions about the prevalence of burnout and how to address it.

    The authors originally planned to conduct a systematic review of the 182 studies on physician burnout. They found, however, that the definition of "burnout" varied so much between studies that the authors could not draw any conclusion about the prevalence or impact of burnout. Depending on the definition used, the authors found, estimated rates of physician burnout range from 0% to 80%.

    According to Douglas Mata, a coauthor of the JAMA study and a physician at Brigham and Women's Hospital, some studies "label someone as burned out if they feel exhausted one day out of the week," while others "only label [physicians] as burned out if [they] are exhausted and feel depersonalized and have a low sense of personal accomplishment every day." 

    How can providers fight burnout?

    If "burnout" is such a poorly defined term, why is the word used so widely in the medical community? According to Katherine Gold, a coauthor of an editorial in the JAMA issue, "burnout is much less stigmatized than depression. People are just more willing to say they're burned out."

    According to Gold, most studies fail to consider the "nuances" of physician fatigue. That means, she said, there is a "need for a lot more research to understand what is happening," she said.

    Administrative duties—and the increasing amount of time doctors spend on them—are one source of physician distress, Gold said. "We know anecdotally that physicians are often really frustrated by the non-doctor things that we have to do: the charting, the things that we aren't trained to do," Gold explains. "[Primary] care physicians are spending less time with our patients and much more time on clerical activities. That, I think, causes stress, but not necessarily burnout."

    Separately, Mata said, despite the disparate definitions, that "[t]he concept of burnout" is still "useful because it conceptualizes workers' responses to systems." He explained, "It doesn’t suggest that you need to treat the (worker) but rather to fix the work environment."

    According to Gold, it is the responsibility of the institution, not the physician, to address sources of stress and fatigue. Instead of asking physicians whether they experience stress or anxiety, researchers and medical institutions need to identify the "external demands" that frustrate physicians, Gold said (Carroll, Reuters, 9/18; Gordon, "Shots," NPR, 9/18).

    Learn more: Get 4 key strategies to mitigate physician burnout

    Physician burnout links to a 16% decrease in patient satisfaction, an 11% increase in reported medical errors, increased turnover, and early retirement. Act now to prevent further damage to your business, physicians, and patients.

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