Physician burnout improving, still high comparatively

Satisfactory work-life balance remains a challenge for America's doctors compared to the general workforce, researchers say, but at least levels of outright physician burnout seem to be improving.

Published in the journal Mayo Clinic Proceedings, the new study found satisfaction with both work-life integration and burnout among U.S. physicians improved between 2014 and 2017, with few variations by specialty; however, both remained markedly higher than the overall U.S. working population. Researchers believe such trends could signify physicians' eventual adjustment to ill-reputed health IT changes or heightened awareness of the toxic effects of burnout.

"This is good news," says Lotte Dyrbye, M.D., Mayo Clinic researcher and senior author of the report, in a news release. "It shows that burnout is being addressed nationally and programs are having some impact."

A chronic state of emotional, physical or mental exhaustion, burnout can have significant health consequences that can lead to fatigue and irritability, or even high blood pressure and substance misuse. Particularly, physician burnout made headlines in recent years, often attributed to a shifting focus from direct patient care to an emphasis on electronic recording and reporting. But countless factors play into physician burnout as evidenced by the latest research from the Mayo Clinic, American Medical Association and Stanford University.

The results are in

Per the results of a nationwide physician survey in 2017-and compared to a similar 2011 survey-researchers found that 60% of physicians feel their work schedule hinders family or personal time, compared to only 40% of the general U.S. workforce. Likewise, nearly 44% of physicians report feeling burned out as compared to only 28% of the general workforce.

However, those numbers are still better than how physicians responded in 2014. Then, about 59% felt work impeded their family or personal time and about 54% reported feeling burned out.

Independently, being a woman and working more hours per week were associated with higher rates of burnout and lower satisfaction with work-life integration, while practicing in certain specialties was also associated with burnout. For example, "emergency medicine," "OB/GYN" and "family medicine" practitioners were most likely to report burnout, while "ophthalmology" fell near the least likely to report burnout.

So why are things getting better? Researchers note 2014 may have been "a particularly challenging time" as hospitals and practices consolidated, EHR use became far more widespread, and administrative burdens increased. Now, three years later, physicians either adapted to those circumstances or left their profession entirely.

"Many organizations have also made substantive efforts to improve the efficiency of the practice environment through better team-based care, documentation assistance and streamlined workflows," the study notes. "These and other efforts to improve physician well-being have proven to be efficacious and should be recognized as potential contributors to the favorable trend."

Although optometry wasn't one of the 20 specialties included in the study, the profession often holds a distinction for being among the "best jobs" due to good work-life balance and an average stress level. That said, each practice setting is unique and physician burnout can take a costly toll no matter where it strikes.

Strategies to manage stress

The AOA's Ethics Forum, an online resource for AOA members' quandaries about common ethical challenges in optometric practice, presented physician burnout as its first case study. Titled, "The Modern Practice and Optometrist Burnout," the case study introduces burnout as an ethical dilemma that affects patient care.

Citing a chapter of An Optometrist's Guide to Clinical Ethics, written by Michael Larkin, O.D., authors note several self-reflection questions to gauge personal stress:

• Am I providing quality care as I have increased my patient load?
• Have I reached the limit of my own mental or physical capacity, increasing the risk that I might make errors in diagnosis or treatment?
• Am I becoming unhappy with myself, my patients or my profession because I feel overworked or burned out?

"Answering 'yes' to even one question should be cause to begin to address the issues causing stress or even burnout," the case study notes.
"Burned out or not, we have standards for the care we know we should be providing."

Beyond the case study, the Ethics Forum offers six takeaways to help manage stress, including:

1. Manage your time efficiently. Be organized, schedule realistically and do not overcommit yourself. Set priorities and boundaries, and maintain these limits while learning to say, "no."
2. Anticipate, prepare for situations. This goes for both at work and home. Don't spend time trying to do things "the way it's always been done" or finding the "perfect" way. Look for options, set realistic expectations of yourself and accept that good enough is good enough.
3. Create a financial plan. Stick to wise principles, reduce debt and save. Being financially overcommitted is the second-most common reason that physicians do not make changes to decrease their levels of stress.
4. Leave work at work. Don't take it home-define when and where you will work and stick to it. Give your family your full, undivided attention when you are with them.
5. Care for yourself. Take care of yourself by scheduling regular breaks, leisure activities and vacations. Eat properly, get enough sleep and stay physically active, too. Time for yourself can be an investment that allows you to be more readily available for all your other responsibilities. Look for, and enjoy, humor on a regular basis to bring fun to work.
6. Find a mentor. Share concerns with trusted colleagues and ask for help if needed. Develop a support system and have at least one good friend who you can confide in and rely on to help.