One study found that nearly half of junior physicians were already
having burnout symptoms at least one day a week.
The other study underscored how hard it is to assess the problem.
After reviewing previous studies, researchers found huge variations
in definitions of burnout and estimated rates among doctors, which
ranged from 0 to 80 percent.
"With two lead articles in one of the most prominent medical
journals in the world, it means that burnout is now being taken
seriously by the medical mainstream," said Dr. Albert W. Wu, an
internist and professor of health policy & management at the Johns
Hopkins Bloomberg School of Public Health in Baltimore, Maryland.
"It is being endorsed at an alarming rate by physicians who range
from trainees to seasoned veterans and it is accompanied by other
disturbing correlates that include a high rate of suicidal ideation,
regret about one's job choice and an acknowledgement of not being
one's best self in practicing medicine," Wu said. "This represents a
crisis in slow motion."
Doctors' workloads have changed considerably over the years. Today
they spend less time interacting with patients. Instead, "physicians
are spending a lot of time trying to get authorizations for
treatment that they know their patients need and insurance companies
won't pay for," Wu said. "Insurance companies and others have
discovered the way to get doctors to order fewer tests and
medications is to make it a huge hassle to get them."
This may partly explain why nearly 50 percent of young doctors in
post-medical-school training programs called residencies reported
burnout at least one day a week. And a large number felt they had
made a mistake in choosing a subspecialty, such as pathology or
anesthesiology, or even medicine in general as a profession.
That study followed 3,588 physicians, who were surveyed during their
last year of medical school and again in their second year of
residency. Along with a host of demographic questions, the doctors
were asked to rate themselves on two statements: "I feel burned out
from my work" and "I've become more callous toward people since I
started this job."
Those questions were designed to capture two of the three symptoms
that fit the classical definition of burnout: exhaustion and
feelings of depersonalization. The third symptom would be a low
sense of personal accomplishment.
Residents were also asked two questions designed to illuminate
regrets they might have about their careers: "If you could revisit
your career choice would you choose to become a physician again?"
and "If you could revisit your specialty choice, would you choose
the same specialty again?"
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Overall, 45 percent of residents reported at least one symptom of
burnout at least once a week, while 14 percent reported career
choice regret.
While once a week may not sound like a lot, physicians who feel
burnout this often are more likely to report thinking about suicide,
making a major medical error and wanting to leave medicine, said
lead author Dr. Lotte Dyrbye, who co-directs the physician
well-being program at the Mayo Clinic in Rochester, Minnesota.
"Burnout is very much a real thing," Dyrbye said.
And it's especially prevalent among physicians, Dyrbye said, noting
that while doctors may have close to a 50 percent burnout rate,
among other U.S. workers the rate is under 30 percent.
Still, Dyrbye said, "We need more research in the field with good
attention to method."
The authors of the other JAMA study would most likely agree. They
originally planned to analyze data combined from previous studies.
But after gathering 182 reports involving 109,628 physicians from 45
countries, they determined that the definitions of burnout and the
study methods were so disparate that it was impossible to draw any
conclusions.
For example, "some studies will label someone as burned out if they
feel exhausted one day out of the week," said coauthor Dr. Douglas
Mata of the Brigham and Women's Hospital and Harvard Medical School
in Boston. "Others . . . only label you as burned out if you are
exhausted and feel depersonalized and have a low sense of personal
accomplishment every day."
Mata says researchers need to find the best way to quantify
physicians' responses to chronic occupational stress. "The concept
of burnout is useful because it conceptualizes workers' responses to
systems," he said. "It doesn't suggest that you need to treat the
(worker) but rather to fix the work environment."
SOURCE: http://bit.ly/2OzSTfV, http://bit.ly/2OyOpWJ and http://bit.ly/2OyON7D
JAMA, online September 18, 2018.
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